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College  of  pijj'giciansi  anti  burgeons 


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http://www.archive.org/details/successindentalp1904john 


SUCCESS 

IN 

DENTAL    PRACTICE 


SUCCESS 

IN 


Dental  Practice 


A  Few  Suggestions  Relative  to  the  Most 

Approved  Methods  of  Conducting 

a  Practice 


BY 
C.   N.  JOHNSON,  M.A.,  L.D.S.,  D.D.S. 

Professor   of   Operative  Dentistry  in   the   Chicago   College   or 

Dental    Surgery  ;    Editor   of    the   Dental  Re-vieiv,   and 

Author  of   "  Principles  and   Practice   of 

Filling  Teeth" 


PHILADELPHIA   &=  LONDON 

J.   B.   LIPPINCOTT    COMPANY 
1903 


Copyright,  1903 

BY 

J,  B.  LippiNcoTT  Company 

Published  April,  1903 


Electrotyped  and  Printed  by 
7.  B.  Lippincott  Company,  Philadelphia,  V,  S.  A. 


Preface 


The  charge  has  frequently  been  made  that 
dentists  as  a  class  are  seriously  at  fault  with 
regard  to  the  methods  employed  in  the  business 
management  of  their  affairs.  Probably  it  would 
be  more  exact  to  say  that  the  real  charge  is  that 
they  have  no  method.  But  whether  this  be  en- 
tirely true  or  not,  the  fact  still  remains  that  there 
are  few  dentists  whose  affairs  are  so  conducted 
that  they  may  not  be  greatly  improved  by  the 
application  of  good  business  methods. 

When  business  methods  are  mentioned  in  this 
connection  it  is  not  to  be  inferred  that  a  dental 
practice  should  ever  in  any  wise  be  so  conducted 
that  the  commercial  element  is  allowed  to  pre- 
dominate over  the  professional.  Commercialism 
is  a  serious  menace  to  any  profession ;  but  there 
is  a  vast  distinction  between  an  offensive  com- 
mercialism and  that  methodical  conduct  of 
affairs  which  results  in  a  successful  practice  and 

5 


6  PREFACE 

a  financial  balance  on  the  right  side  of  the  ledger 
at  the  end  of  each  year.  No  man  is  doing  his 
full  duty  to  himself,  to  his  profession,  or  to  those 
dependent  upon  him  who  completely  ignores  this 
phase  of  his  professional  life,  as  some  practi- 
tioners seem  to  do,  and  it  should  no  longer  be 
considered  any  discredit  to  a  dentist  to  devote 
part  of  his  talents  to  the  accumulation  of  a  com- 
petence. 

The  suggestions  in  this  book  are  naturally  in- 
tended for  the  most  part  to  apply  to  the  younger 
members  of  the  profession,  though  it  is  con- 
fidently believed  that  even  those  long  in  practice 
may  derive  benefit  from  a  study  of  the  plans  laid 
down.  It  is  not  expected  that  practitioners 
firmly  settled  in  their  ways  will  revolutionize 
their  methods  in  accordance  with  the  suggestions 
herein  contained ;  and  yet  a  consideration  of  the 
question  cannot  fail  to  be  of  advantage  to  any 
man,  even  of  the  most  extended  experience. 

The  book  is  not  offered  as  a  panacea  for  all 
the  ills  which  harass  a  dentist  in  the  conduct  of 
his  practice,  but  merely  with  the  hope  that  it 
may  prove  of  some  small  service  in  attempting 
to  establish  an  equitable  and  intelligent  relation- 


PREFACE  7 

ship  between  the  practitioner  and  the  pubHc.  If 
this  is  accompHshed  it  will  make  the  work  of  the 
dentist  more  pleasant  and  assuredly  more  profit- 
able. 

C.  N.  J. 


Contents 

¥ 

PAGE 

I.  The  ^\rraxgement  of  an  Office ii 

II.  Winning  Patronage i8 

III.  Location   48 

IV.  Extending  Acquaintance 54 

V.  Managing  Patients  63 

VI.  Records  and  Book-keeping  77 

VII.  Appointments  and  Sittings 100 

VIII.  Giving  Credit,  Collecting  Accounts,  Paying 

Bills  106 

IX.  Fees  127 

X.  Employing  an  Assistant I43 

XL  Economy    in     Purchase    and    in     Avoiding 

W.\STE    145 

XII.  Bank  Account  and  Investments  151 

XIII.  Professional  Relationship  and  Citizenship  156 


Success  in  Practice 
I 

THE   ARRANGEMENT   OF  AN    OFFICE 

The  Reception-Room.  —  The  economy  of 
space,  particularly  in  localities  where  rents  are 
high,  is  an  important  factor  in  the  arrangement 
of  an  office.  If  the  practice  is  conducted  in  a 
methodical  and  systematic  manner,  and  the  work 
is  done  by  appointment,  as  it  should  be,  there  is 
little  need  for  a  large  reception-room.  Under 
these  circumstances  it  is  unusual  for  many  people 
to  be  in  this  room  at  one  time,  or  for  any  one  to 
remain  there  long.  And  yet  those  who  are  there 
should  be  pleasantly  entertained  by  a  diversity 
of  reading-matter  on  the  centre-table.  The  selec- 
tion of  this  matter  requires  some  judgment,  in 
view  of  the  difference  in  tastes  among  patients. 
It  should  run  the  gamut  in  periodicals  from 
short,  crisp  story-books  to  the  heavier  and  pro- 


12  SUCCESS   IN   PRACTICE 

founder  magazines.  It  is  almost  unnecessary 
to  say  that  flashy  literature  of  any  kind  has  no 
place  in  a  dental  office.  Old,  back-numbered, 
and  dog-eared  magazines  should  be  rigidly  dis- 
carded, unless  perchance  some  such  magazine 
may  contain  a  very  able  article  which  has 
strongly  appealed  to  the  dentist,  or  has  a  sug- 
gestive bearing  on  contemporaneous  thought. 
Such  an  article  should  be  heavily  underlined  on 
the  title-page  and  the  article  itself  red-pencilled 
to  call  attention  to  it.  The  ordinary  dental  jour- 
nals are  out  of  place  in  the  reception-room,  on 
the  ground  that  everything  which  smacks  of  the 
shop  should  be  excluded  from  this  part  of  the 
office. 

A  reception-room  should  be  cheerful  and  in- 
viting, with  an  air  of  comfort  and  culture  about 
it.  If  the  dentist  himself  is  lacking  in  the  requi- 
site taste  to  fit  it  up  in  this  way,  he  would  better 
consult  some  one  who  has  the  taste, — preferably 
a  lady, — best  of  all  his  wife. 

The  Operating-Room. — In  view  of  the  fact 
that  the  dentist  spends  most  of  his  working 
hours  in  this  room,  it  is  important  that  he  gives 
the   closest   attention   to   its   arrangement.      It 


THE   ARRANGEMENT   OF   AN    OFFICE 


13 


should  be  well  ventilated  at  all  times,  and  if 
possible  should  admit  the  sunlight.  A  good 
arrangement  is  to  have  two  windows,  one  facing 
the  south,  to  allow  the  sun  free  admission  during 
the  winter  months,  and  the  other,  preferably  an 
east  light,  for  operating.  A  corner  room  facing 
the  southeast  seems  in  many  respects  the  most 
desirable  arrangement.  In  summer  the  sun  is 
so  high  that  its  rays  do  not  enter  the  south  win- 
dow in  mid-day  to  any  uncomfortable  extent, 
but  flood  the  east  window  early  in  the  morning 
and  move  around  out  of  range  by  the  time  oper- 
ating begins.  In  winter  the  south  window  ad- 
mits the  sunlight  to  the  room  at  the  operator's 
back  through  most  of  the  operating  hours,  which 
at  this  time  of  the  year  particularly  is  a  matter 
of  great  importance  so  far  as  the  dentist's  health 
is  concerned. 

The  problem  of  light  is  a  very  important  one, 
both  as  it  relates  to  effective  work  and  to  the 
preservation  of  the  operator's  eyes.  This  mat- 
ter is  too  often  overlooked  by  dentists,  either 
through  thoughtlessness  or  a  failure  to  under- 
stand the  real  requisites  of  an  operating  light. 
The  impression  seems  to  prevail  that  the  more 


14  SUCCESS   IN   PRACTICE 

light  in  the  room  the  better,  while  the  fact  is  that 
too  much  light  is  altogether  disastrous.  The 
only  light  needed  for  operating  is  that  which 
shines  directly  into  the  patient's  mouth,  and 
therefore  the  area  of  the  operating  window  need 
not  be  large.  A  window  three  or  four  feet  wide 
is  ample,  and  it  should  be  situated  well  up  to- 
wards the  ceiling.  The  idea  is  to  concentrate 
the  light  as  much  as  possible  at  one  point, — viz., 
in  the  vicinity  of  the  head-rest  of  the  chair.  Of 
course,  allowances  must  be  made  for  raising  and 
lowering  the  chair,  but  any  extra  rays  of  light 
other  than  those  in  actual  use  in  lighting  the 
patient's  mouth  are  a  positive  detriment.  A 
bright  flooding  of  the  room  in  the  region  to- 
wards which  the  operator  faces  is  a  serious  tax 
on  his  eyes  and  will  sooner  or  later  ruin  them. 
An  element  of  particular  danger  lies  in  reflected 
light  being  thrown  up  in  his  face  while  oper- 
ating, and  in  this  respect  few  operators  are  suf- 
ficiently alive  to  their  best  interests.  The  color 
of  the  wall-paper  or  tinting  is  seldom  considered 
except  with  the  idea  of  having  a  pleasing  shade, 
and  these  shades  are  usually  selected  in  bright 
colors.     Nothing  could  be  worse  for  an  oper- 


THE   ARRANGEMENT   OF   AN   OFFICE  15 

ating-room.  All  bright  colors  reflect  tlie  light, 
and  the  operator  who  daily  faces  such  a  wall  is 
unconsciously  subjecting  himself  to  eye-strain 
which  must  eventually  impair  his  vision.  This 
matter  has  been  sufficiently  tested  in  a  practical 
way  to  leave  no  doubt  of  its  importance,  and  the 
suggestion  is  hereby  strongly  urged  for  oper- 
ators to  tint  the  walls  of  their  operating-rooms 
in  some  of  the  neutral  shades  which  absorb  the 
light  instead  of  reflecting  it  back  in  the  oper- 
ator's eyes.  A  color  which  has  proved  for  years 
a  most  satisfactory  one  and  which  is  not  in  any 
way  sombre  in  effect  is  a  soft  chocolate.  There 
is  a  sense  of  restfulness  to  the  eyes  in  an  oper- 
ating-room tinted  in  this  shade  which  in  the 
course  of  years  becomes  a  really  important  fac- 
tor in  the  comfort  of  daily  work. 

The  sunlight  which  streams  in  at  the  oper- 
ator's back  from  the  south  window  in  winter  is 
no  tax  on  the  eyesight,  because  the  operator  does 
not  face  it,  and  with  a  wall  tinted  as  just  indi- 
cated there  is  no  glare,  even  when  the  light  does 
strike  it. 

Consultation-  and  Dressing-Room.  —  Where 
economy  of  space  is  important,  these  two  rooms 


1 6  SUCCESS   IN   PRACTICE 

may  be  combined  in  one.  It  is  necessary  in  a 
busy  practice  to  have  some  small  room  conven- 
ient to  the  operating-room  where  brief  exami- 
nations may  be  made  or  emergency  cases  treated 
without  disturbing  the  patient  in  the  chair.  As 
a  rule  it  should  be  the  aim  of  the  operator  to 
avoid  leaving  a  patient  during  an  operation,  but 
emergencies  occasionally  arise  which  insist  on 
immediate  attention  and  where  a  few  moments 
will  suffice  to  adjust  any  passing  trouble  and 
leave  the  dentist  free  to  complete  his  operation 
unmolested.  The  fact  of  some  one  waiting  in 
the  reception-room  to  see  him  is  always  more  or 
less  of  a  distraction  to  an  operator,  and  a  con- 
venient consultation-room  will  often  relieve  him 
of  this  annoyance.  This  same  room  may  be  used 
as  a  dressing-room,  the  operator  having  no  use 
for  it  while  changing  patients. 

The  Laboratory. — This  room  is  too  often  a 
disgrace  to  a  professional  man  in  being  made 
the  dumping-ground  for  all  the  rubbish  of  the 
office  and  in  the  amount  of  dirt  and  dust  that 
is  allowed  to  accumulate  in  it.  The  opinion 
which  seems  to  prevail  among  practitioners  that 
the  laboratory  must  of  necessity  be  more  or  less 


THE   ARRANGEMENT   OF   AN   OFFICE 


17 


untidy  on  account  of  the  work  which  is  per- 
formed therein  is  erroneous.  It  may  be  kept 
presentable  at  all  times,  and  may  even  be  made 
attractive,  if  the  practitioner  takes  sufficient 
pride  to  keep  it  so.  It  is  merely  a  question  of 
devising  a  ready  means  of  getting  rid  of  the 
refuse  as  fast  as  it  accumulates  and  not  allowing 
old  plaster  or  other  evil-smelling  products  to  lie 
around  in  sight.  A  little  systematic  tidiness  in 
the  laboratory  will  well  repay  any  dentist  who 
takes  the  least  pride  in  the  general  appearance 
of  his  office,  and  if  managed  in  the  proper  man- 
ner it  will  not  consume  an  appreciable  amount 
of  time. 


II 

WINNING   PATRONAGE 

Advertising. — After  an  office  is  fitted  up,  the 
next  consideration  is  to  secure  patients.  This 
is  a  problem  which  has  taxed  the  minds  of  very- 
many  in  the  profession,  and  yet  it  is  really  a 
simple  matter  if  approached  in  the  right  way. 
The  most  fatal  mistake  a  young  man  can  make 
is  to  attempt  to  gain  a  practice  by  newspaper 
advertising.  This  statement  is  made  in  the  pres- 
ent connection  entirely  aside  from  any  considera- 
tion of  the  ethical  phase  of  the  question.  Even 
if  it  were  perfectly  ethical  to  resort  to  circulars, 
or  hand-bills,  or  posters,  or  display  advertise- 
ments in  the  public  prints,  it  would  still  remain 
a  bad  business  policy  in  a  profession  like  den- 
tistry. While  there  are  always  exceptions  to 
every  rule,  the  generality  of  patients  who  come 
to  a  dentist  as  the  result  of  this  kind  of  adver- 
tising are  not  of  the  class  which  make  good  pa- 
tronage for  any  self-respecting  young  man. 
i8 


WINNING   PATRONAGE  I9 

Even  if  newspaper  advertising  per  se  were  in  no 
wise  objectionable,  the  depths  to  which  it  has 
been  dragged  by  irresponsible  impostors  would 
tend  to  brand  it  as  a  doubtful  expedient  for 
honest  men  to  traffic  with.  The  stigma  of  the 
"  dental  parlor"  is  a  shadow  which  no  young 
man  can  afford  to  have  trailing  after  him 
through  life.  Unless  there  be  present  in  the  in- 
dividual himself  those  qualities  which  draw  and 
hold  people  to  him  by  the  force  of  his  own  per- 
sonality, newspaper  advertising  will  prove  at 
best  only  a  temporary  advantage  to  be  imme- 
diately lost  the  moment  the  advertising  ceases; 
while  if  the  young  man  possesses  those  quali- 
ties, he  assuredly  has  no  need  of  the  newspaper 
to  aid  him.  Few  young  men  start  out  with  the 
idea  of  continuing  throughout  their  entire  pro- 
fessional life  the  habit  of  paying  part  of  their 
income  to  the  newspapers  for  the  purpose  of 
bringing  in  patronage.  Their  plan  usually  is  to 
utilize  this  means  for  a  time  till  they  are  well 
established,  and  then  they  fondly  hope  to  be  in- 
dependent of  such  methods  and  able  to  pilot  their 
own  bark.  The  fallacy  of  this  has  been  demon- 
strated repeatedly.     It  is  the  rarest  possible  ex- 


20  SUCCESS   IN   PRACTICE 

ception  to  find  any  young  man  who  has  resorted 
to  this  kind  of  advertising  ever  to  attain  to  any 
prominence  in  the  profession,  or  to  succeed  per- 
manently in  a  financial  way.  Even  laying  aside 
the  question  of  respect  on  the  part  of  profes- 
sional associates,  the  history  of  professional  men 
generally  will  amply  prove  that  there  is  no  tan- 
gible or  lasting  success  to  be  had  by  this  plan. 
But  granted  that  there  were,  this  question  of  re- 
spect cannot  be  laid  aside.  Men  may  talk  loftily 
and  loudly  about  not  caring  what  the  profession 
thinks  of  them  so  long  as  they  make  the  money, 
but  sooner  or  later,  money  or  no  money,  there 
comes  to  the  heart  of  every  man  an  overwhelm- 
ing desire  to  be  thought  well  of  by  his  fellows. 
He  may  hide  it  for  a  time  behind  the  mask  of 
an  artificial  complacency,  but  it  will  not  down. 
It  is  human  nature.  If  there  is  a  man  who  is 
devoid  of  this  desire,  he  is  far  more  to  be  pitied 
than  envied  or  emulated,  and  in  that  man  there 
is  not  the  element  of  true  happiness. 

A  revelation  of  this  character  came  to  the 
present  writer  while  he  was  yet  a  young  man 
starting  out  in  practice.  It  so  befell  that  he 
chanced  to  meet  and  talk  with  an  elderly  prac- 


WINNING   PATRONAGE  21 

titioner  in  another  profession  who  had  almost  a 
national  reputation  for  quackery.  He  was  quite 
generally  accounted  to  be  the  chiefest  exponent 
of  quack  methods  of  his  time,  and  was  consid- 
ered a  prince  in  his  way  and  one  who  was  bril- 
liantly successful  along  those  lines.  It  was 
supposed  that  he  had  grown  wealthy  by  his 
methods,  and  that  he  cordially  despised  the  "  so- 
called  ethics"  of  professional  life.  Said  he  to 
me:  *'  I  suppose  that  you  intend  to  practise  den- 
tistry ethically,  do  you?"  I  thought  I  detected 
the  semblance  of  a  sneer  in  his  remark,  but  I 
had  the  courage  to  say  to  him  that  such  had  been 
my  intention  from  my  student  days,  and  that 
I  saw  no  reason  for  changing  my  views.  He 
looked  at  me  a  moment  wath  a  queer  expression, 
which  soon  took  on  a  serious  turn,  and  then 
broke  out :  "  My  dear  boy,  whatever  you  do, 
stick  to  that.  It  is  the  only  certain  road  to  suc- 
cess in  a  profession.  I  should  hate  to  see  a  young 
man  like  you  make  the  deplorable  mistake  in 
life  that  I  have  made," — only  he  did  not  use  the 
word  "  deplorable."  And  then  he  painted  such 
a  picture  of  what  his  life  really  was,  in  contra- 
distinction to  what  the  world  thought  it  was  and 


22  SUCCESS   IN   PRACTICE 

what  he  wished  it  were,  that  I  never  have  es- 
caped the  impression  his  recital  made  upon  me. 

The  inner  history  of  every  man  who  has  fol- 
lowed quack  methods  for  building  up  a  practice 
will  disclose  the  fact  that  there  is  something 
fundamentally  wrong  with  the  method.  A  man 
who  always  remains  a  quack  eventually  fails  in 
the  respect  of  his  fellow-men  as  well  as  his  fel- 
low-practitioners, and  he  who  starts  out  as  a 
quack  with  the  ultimate  intention  of  reforming 
and  becoming  ethical  as  soon  as  his  practice  is 
established  will  find  that  the  stigma  of  his  early 
methods  will  cling  to  him  long  after  he  has  dis- 
carded them,  and  will  crop  out  and  embarrass 
him  throughout  his  entire  professional  career. 

Essentials  to  Success. — If  it  be  true,  then,  that 
quackery  is  a  failure  as  well  as  a  wrong,  by  what 
means  shall  a  young  man  draw  a  patronage  to 
himself  in  such  a  way  that  he  may  be  both  suc- 
cessful and  respected  ?  I  have  stated  that  this  is 
a  simple  matter,  and  so  it  is;  but  the  require- 
ments for  carrying  it  out  are  somewhat  exacting 
and  cannot — must  not — be  ignored. 

No  single  element  in  a  man's  make-up  will 
be  found  all-sufficient  to  ensure  success  in  dental 


WINNING   PATRONAGE  23 

practice.  In  fact,  to  be  a  successful  dentist  re- 
quires a  rare  combination  of  qualities  more 
exacting  than  for  that  of  any  other  calling.  This 
statement  would  seem  formidable  and  discour- 
aging were  it  not  for  the  fact  that  these  quali- 
ties are  such  that  they  can  be  cultivated  and  ac- 
quired by  almost  any  young  man  of  ordinary 
ability.  There  are  some  stations  in  life  which 
to  fill  properly  demand  of  a  man  an  inherent 
genius  in  one  certain  direction,  a  genius  born  in 
him.  and  which,  lacking  this  birthright,  cannot 
be  cultivated  to  a  successful  issue.  A  great  mas- 
ter, whether  of  music,  or  art.  or  literature,  can- 
not be  made  of  common  clay;  neither  can  the 
breadth  of  brain  necessar}'-  to  make  a  successful 
President  of  the  United  States  be  imparted  to 
a  man  by  education.  The  solving  of  great  prob- 
lems which  affect  the  destiny  of  nations  or 
masses  of  people  requires  a  mental  capacity  not 
inherited  by  the  average  man  and  which  the 
average  man  cannot  acquire  by  study.  For  such 
things  a  peculiar  mental  calibre  is  requisite 
which  marks  a  man  as  something  apart  from  his 
fellow-men  and  gives  him  a  distinctive  position 
in  the  world. 


24  SUCCESS   IN   PRACTICE 

Of  such  is  not  the  practice  of  dentistry,  and 
yet  I  must  hasten  to  add  that  in  this  statement 
I  do  not  in  any  wise  admit  a  place  of  minor  im- 
portance for  our  calHng  so  far  as  relates  to  its 
honor,  its  dignity,  or  its  usefulness  in  the  world. 
It  is  merely  that  the  chief  requisites  for  the  suc- 
cessful practice  of  dentistry  are  such  as  can 
largely  be  cultivated,  not  of  course  by  every 
chance  ignoramus  or  sluggard,  but  by  the  hun- 
dreds of  bright,  energetic  young  men  who  are 
yearly  entering  its  ranks. 

Efficiency. — In  attempting  to  enumerate  some 
of  these  requisites  the  first  place  must  unequivo- 
cally be  assigned  to  efficiency.  Unless  a  man  be 
a  good  dentist  and  eminently  qualified  to  serve 
his  patients  skilfully,  he  is  handicapped  at  the 
very  foundation ;  and  the  thing  for  a  young  man 
to  do,  if  he  finds  himself  lacking  in  skill  in  any 
department  of  his  work,  is  to  so  apply  himself 
that  the  deficiency  is  overcome  and  he  finds  him- 
self on  a  level  with  the  best.  Mediocrity  will 
not  win  in  this  age  of  active  progress, — to-day 
there  is  little  room  in  the  profession  for  the 
"  average  man."  People  are  becoming  too  dis- 
criminating to  allow  a  man  of  meagre  attain- 


WINNING   PATRONAGE 


25 


ments  to  impose  on  them  for  any  length  of  time, 
and  the  condition  no  longer  exists  where  mere 
glibness  of  tongue  can  compensate  for  lack  of 
ability. 

It  may  seem  a  vague  sort  of  advice  to  tell  a 
young  man  to  become  proficient  in  his  work,  but 
what  is  meant  is  this :  With  almost  every  recent 
graduate  there  are  some  things  which  seem  more 
easy  of  accomplishment  than  others,  and  prob- 
ably at  least  a  few  things  which  seem  exceed- 
ingly difficult.  For  instance,  he  may  find  that 
to  build  a  gold  filling  properly  in  a  disto-occlusal 
cavity  in  a  lower  molar  or  bicuspid  is  a  prob- 
lem which  taxes  him  to  the  uttermost,  and  of  the 
result  of  which  he  is  never  certain.  The  thing 
for  him  to  do  the  moment  he  recognizes  this 
particular  limitation  is  to  devote  his  every  energy 
to  the  mastery  of  this  class  of  cavities.  Let  him 
seek  all  the  light  possible  on  the  subject  from  the 
literature  of  the  profession,  and  let  him  request 
the  privilege  of  watching  some  skilful  operator 
fill  such  a  cavity.  Let  him  study  the  problem 
from  ever}^  available  point  of  view  and  never 
rest  content  till  his  brain  has  conceived  the  best 
way  of  accomplishing  the  result  and  his  fingers 


26  SUCCESS   IN   PRACTICE 

have  learned  how  to  execute  it.  Success  in  Hfe 
is  attained  only  by  the  constant  overcoming  of 
obstacles,  and  unless  a  dentist  brings  this  per- 
sistent determination  into  his  daily  work  he  need 
never  hope  to  rise  above  mediocrity.  I  would 
much  rather  see  in  a  young  man  the  disposition 
to  plot  and  dig  and  delve,  and  the  patience  to 
persevere,  than  to  see  the  highest  degree  of  bril- 
liancy unaccompanied  by  seriousness  of  purpose 
or  continued  application. 

No  young  man  in  the  practice  of  dentistry  to- 
day can  afford  to  stop  short  of  the  greatest  pos- 
sible proficiency  in  his  work.  A  bungling 
method  of  operating,  or  a  seeming  lack  of  deci- 
sion as  to  the  precise  thing  to  do  in  a  given  case, 
is  instantly  recognized  by  the  patient,  and  a  men- 
tal note  made  of  it;  while  a  ready,  sharp,  and 
decisive  line  of  procedure,  with  no  hesitation  or 
doubt,  appeals  at  once  to  the  patron  and  creates 
confidence.  The  man  who  approaches  an  opera- 
tion with  the  conscious  conviction  that  he  is 
entire  master  of  the  situation,  unerringly  com- 
mands the  co-operation  of  the  patient  and  ac- 
complishes his  work  under  the  most  favorable 
conditions.    It  is  this  which  draws  people  to  him 


WINNING   PATRONAGE  27 

and  which  holds  them  in  the  firm  grasp  of  an 
estabhshed  confidence. 

Personal  Habits. — Another  requisite  in  build- 
ing a  practice  relates  to  the  personal  habits  of 
the  dentist.  The  chief  article  in  the  dental  faith 
may  be  written  in  one  word, — clcanlbicss;  and 
there  is  no  other  single  word  so  big  with  possi- 
bilities as  this.  The  operator  on  approaching  a 
patient  should  be  the  very  pink  and  essence  of 
purity.  His  linen  should  be  clean,  his  person 
irreproachable  by  frequent  bathing,  his  face 
fresh  shaven  every  morning,  if  he  shaves  at  all, 
and  his  hands  most  scrupulously  cared  for.  The 
finger-nails — oh,  ye  immaculate  gods  of  pris- 
tine purity,  how  often  have  ye  been  offended  by 
the  finger-nails  of  dentists !  There  never  was, 
there  never  can  be,  any  excuse  for  a  dentist 
starting  to  work  on  a  patient's  mouth  with  soiled 
finger-nails.  No  matter  how  many  patients  the 
operator  may  have  in  a  day,  he  should  wash  his 
hands  thoroughly  and  dry  them  carefully  every 
time  a  patient  takes  the  chair.  And  this  should 
invariably  be  done  in  the  presence  of  the  patient 
as  the  very  last  act  preceding  the  commencement 
of  the  operation.    When  a  discriminating  patient 


28  SUCCESS  IN   PRACTICE 

sees  the  dentist  hang  up  the  towel  from  drying 
his  hands,  and  go  at  once  to  his  work,  there  is  a 
settled  sense  of  satisfaction  on  the  patient's  part 
which  though  often  unexpressed  is  none  the  less 
a  potent  factor  when  it  comes  to  recommending 
other  people  to  a  dentist. 

There  is  never  any  precaution  too  great  to 
be  taken  in  avoiding  offensiveness  of  whatever 
character  connected  with  the  personality  of  the 
dentist.  His  breath  should  be  the  object  of  es- 
pecial care,  and  he  should  eschew  all  food  mate- 
rials calculated  in  any  way  to  leave  a  taint  upon 
it.  To  smoke  during  office  hours  is  the  great 
unpardonable  sin,  and  no  dentist  who  has  any 
respect  either  for  himself  or  for  his  patient  will 
commit  such  a  breach. 

It  would  seem  to  go  without  saying  that  the 
teeth  of  the  dentist,  above  all  things  else,  should 
be  given  the  most  scrupulous  care,  and  he  who 
fails  in  this  respect  cannot  well  hope  to  impress 
his  patients  when  he  advocates  such  attention  on 
their  part. 

The  question  of  cleanliness  must  also  be  car- 
ried beyond  the  person  of  the  dentist,  and  be 
made  to  include  his  office-fittings  and  instru- 


WINNING    PATRONAGE 


29 


ments.  Everything  about  the  chair  should  be 
kept  beyond  reproach,  the  hnen  well  laundried 
and  frequently  changed,  and  the  cuspidor  and 
other  metal  accessories  polished  clean,  bright, 
and  sparkling.  The  slightest  trace  of  neglect 
connected  with  the  cuspidor  becomes  exceed- 
ingly offensive  to  individuals  of  fastidious 
tastes,  and,  even  aside  from  sanitary  conditions, 
such  neglect  is  short-sighted  and  prejudicial.  The 
instruments  should  be  cleaned  after  each  patient 
by  scrubbing  them  thoroughly  w-ith  a  brush  and 
soap  and  water  previous  to  immersing  them  in 
an  antiseptic.  None  of  these  precautions  is  ever 
lost  sight  of  by  discerning  patients,  and  no 
dentist  who  aims  to  gain  and  maintain  a  good 
practice  can  afford  in  the  least  to  ignore  them. 

Deportment  towards  Patients. — Another  im- 
portant consideration  in  the  building  of  a  prac- 
tice relates  to  the  deportment  of  the  dentist  to- 
wards his  patients.  He  should  at  all  times  be 
absolute  master  of  himself  so  far  as  his  de- 
meanor is  concerned,  and  no  matter  how  many 
little  worries  or  untoward  occurrences  arise 
during  the  day  he  should  never  give  w-ay  to 
impatience   or   ill-humor.      In   the    very   worst 


30  SUCCESS   IN   PRACTICE 

dilemmas  he  should  sustain  himself  by  the  reflec- 
tion that  the  exigencies  which  arise  in  a  dental 
practice  are  usually  not  of  a  profoundly  serious 
matter  and  not  ordinarily  permanent  in  their 
character,  so  that  the  thing  which  appears  like  a 
mountain  to  the  young  man  to-day  may  dwindle 
in  importance  to  a  mole-hill  a  week  or  two  hence. 
To  be  a  perfectly  poised  gentleman  under  every 
species  of  petty  annoyance  is  a  wonderfully 
strong  recommendation  for  any  man,  and  par- 
ticularly so  for  a  dentist.  It  has  a  compelling 
influence  with  his  patients  to  make  matters  run 
smoothly,  and  develops  in  the  office  an  air  of 
quiet  and  restfulness  which  has  a  far-reaching 
effect  among  cultivated  people.  In  all  his  pro- 
fessional relations  he  should  be  the  essence  of 
kindness,  and  if  possible  of  tolerance.  It  is  of 
course  necessary  at  times  to  be  very  firm  in  his 
convictions,  but  his  firmness  should  invariably 
be  so  tempered  with  a  calm  courtesy  that  his  con- 
tention for  the  right  may  never  seem  arbitrary 
or  offensive.  Impulse,  while  in  one  way  an  ener- 
gizing force  in  a  young  man's  character,  is  at 
the  same  time  his  greatest  danger.  Impulse 
sometimes  leads  a  young  man  blindly  to  his  own 


WINNING   PATRONAGE 


31 


destruction ;  and  even  when  it  is  not  so  serious 
as  this,  it  frequently  results  in  his  embarrass- 
ment and  chagrin.  A  good  motto  for  the  impul- 
si\'e  young  dentist  when  a  seeming  affront  has 
been  offered  him  either  by  a  patient  or  by  his 
professional  associates  is  to  "  think  over  night 
before  retaliating."  If  many  a  man  had  waited 
till  the  following  morning  to  write  a  letter  in 
answer  to  some  aggravating  communication  he 
would  have  immeasureably  strengthened  his  case 
and  saved  himself  subsequent  humiliation. 

Strive  to  be  calm  under  all  circumstances. 
The  power  to  remain  calm  in  the  face  of  great 
provocation  is  one  of  the  surest  safeguards 
against  mistake,  and  at  once  places  the  indi- 
vidual at  an  immense  advantage  over  the  man 
who  blusters  and  fumes.  For  any  man  to  habit- 
ually lose  his  temper  is  an  evidence  of  weakness, 
and  for  a  professional  man  like  a  dentist  to  do 
so  is  vulgar.  It  may  sometimes  be  necessary  and 
proper  to  stamp  out  a  grievous  wrong  by  an  ex- 
pression of  righteous  indignation,  but  any  pet- 
tish display  of  temper  is  disgusting  in  the  ex- 
treme and  marks  the  individual  who  indulges  in 
it  as  a  man  unfit  to  assume  professional  relation- 


32  SUCCESS   IN   PRACTICE 

ship  with  cultivated  people.  To  gain  the  reputa- 
tion of  being  a  perfect  gentleman  at  all  times  is 
one  of  the  best  recommendations  a  dentist  can 
have  to  win  him  a  permanent  patronage. 

Morals. — In  line  with  this  and  leading  up  to 
it  is  the  question  of  morals.  This  book  is  not 
written  in  the  spirit  of  pharisaism,  and  yet  a 
consideration  of  success  in  practice  cannot  be 
altogether  divorced  from  the  fundamental  sub- 
ject of  morality.  Leaving  out  of  the  question 
its  religious  or  ethical  feature,  it  still  remains  a 
matter  of  the  greatest  importance  from  a  purely 
business  point  of  view  that  the  dentist  live  an 
upright,  moral  life.  Laxity  in  morals  has  a 
wider-reaching  effect  than  the  average  young 
man  is  likely  to  imagine.  He  cannot  help  real- 
izing of  course  that  respectable  people  do  not 
care  to  patronize  a  dentist  who  is  known  to  be 
morally  bad,  and  yet  he  who  makes  moral  lapses 
often  fondly  hopes  that  his  escapades  are  known 
only  to  the  few  associates  who  take  part  in  them. 
There  never  was  a  greater  fallacy  than  this,  for 
no  matter  how  close  the  bond  of  secrecy  between 
such  associates  may  be,  the  facts  invariably  leak 
out  somehow,  sometime,  somewhere.     Many  a 


WINNING   PATRONAGE  33 

young  man  has  irretrievably  lost  his  reputation 
and  his  practice  as  the  result  of  moral  delin- 
quencies without  seemingly  being  able  to  account 
for  his  failure.  It  is  difficult  to  overestimate 
the  effect  of  morals  on  daily  life  and  practice. 
Even  if  it  were  possible  to  keep  the  knowledge 
of  immorality  from  the  public,  there  is  irrevoca- 
bly a  concomitant  disintegration  of  character 
which  goes  with  an  immoral  life,  and  which 
sooner  or  later  undermines  a  man's  success.  The 
young  man  in  his  orgies  may  foolishly  hope  to 
extend  his  acquaintance  and  gain  patronage 
among  those  with  whom  he  associates,  but  even 
if  such  people  were  calculated  to  make  good  pa- 
tients, it  is  not  always  certain  that  they  care  to 
patronize  a  dentist  who  is  lax  in  his  morals. 
The  relation  of  dentist  to  patient  is  of  so  inti- 
mate a  nature  that  no  ordinary  requirements — 
such  as  those  which  pertain  to  trade — will  suf- 
fice to  establish  confidence,  and  very  often  the 
people  who  are  glad  to  be  hail-fellow  with  a  den- 
tist will  dispense  with  his  professional  services 
simply  because  of  his  hail-fellowship  with  them. 
A  striking  illustration  of  this  came  to  the  atten- 
tion of  the  writer  some  years  ago,  and  is  worth 

3 


34 


SUCCESS   IN   PRACTICE 


relating  as  indicating  the  sentiments  of  at  least 
one  hail-fellow.  On  the  train  I  met  a  finely- 
dressed  gentleman,  who  in  the  course  of  a  long 
journey  became  sufficiently  familiar  to  tell  me 
his  business.  He  was  the  keeper  of  a  famous 
eating-house  and  saloon  in  a  distant  city, — a 
place  I  had  often  heard  mentioned  as  the  resort 
of  the  swell  set  of  the  place.  He  in  turn  asked 
me  what  my  business  was,  and  when  informed 
that  I  was  a  dentist,  he  said :  "By  the  way,  do 
you  know  Dr.  Blank  of  my  city?"  I  replied 
that  I  knew  him  by  reputation,  but  not  person- 
ally. "  Well,"  said  he,  "  he  is  a  royal  good  fel- 
low. He  frequently  comes  to  my  place,  and  we 
spend  many  of  our  evenings  together.  I've  often 
been  out  shooting  and  fishing  with  him,  and,  in 
fact,  I  enjoy  him  very  much."  I  said  that  I 
understood  the  doctor  was  a  very  good  dentist; 
at  which  my  companion  gazed  out  of  the  car- 
window  a  moment,  and  then  ventured  the  re- 
mark that  he  didn't  know  much  about  that.  I 
looked  at  him  inquiringly,  and  he  finally  said: 
"  The  fact  is,  when  any  member  of  my  family 
wants  dental  work  done  I  send  them  to  some 
one  else."     I  remarked  that  this  seemed  rather 


WINNING   PATRONAGE  35 

Strange,  in  view  of  their  great  friendship,  and 
he  repHed :  "  Yes,  it  may  seem  strange,  but 
business  is  business.  Doc.  is  a  good  fellow,  and 
I  like  his  companionship,  but  when  my  wife  or 
my  children  need  the  services  of  a  dentist  or 
a  physician  I  send  them  to  some  one  who  is  a 
good  professional  man  and  not  a  good  fellow. 
To  be  frank  with  you,  I  see  too  much  of  the 
seamy  side  of  life  myself  to  want  to  trust  my 
family  in  the  hands  of  a  man  who  dissipates  in 
any  way." 

Here  was  a  sermon  which,  though  preached 
by  a  saloon-keeper  on  a  sleeping-car  going  fifty 
miles  an  hour,  embodied  as  great  a  lesson  for 
the  professional  man  as  did  the  famous  Sermon 
on  the  Mount  for  the  early  Christians. 

The  simple  truth  is  that  a  moral  life  is  a  more 
important  factor  in  real  success  than  most  people 
imagine.  It  is  the  only  certain  foundation  on 
which  a  professional  practice  can  be  built,  and 
the  sooner  a  young  man  comes  to  a  full  realiza- 
tion of  this  fact  the  better  it  will  be,  not  only 
for  his  peace  of  mind,  but  for  his  material  ad- 
vancement. Bad  habits  disintegrate  always; 
good  habits  invariably  build  up.     And  habit  is 


36 


SUCCESS   IN   PRACTICE 


SO  insinuating,  so  dominating.  It  is  often  said, 
and  truly,  that  bad  habits  are  hard  to  break; 
but  how  many  people  recognize  the  significant 
fact  that  good  habits  are  equally  tenacious  ?  As 
the  years  go  on  towards  maturity  and  the  indi- 
vidual becomes  more  and  more  dominated  by 
habit,  it  will  be  found  as  difficult  to  give  up  a 
good  habit  as  a  bad  one.  This  is  at  the  same 
time  a  most  encouraging  fact  and  a  solemn 
warning.  It  emphasizes  the  far-reaching  im- 
portance of  establishing  good  habits  in  youth 
when  the  individual  is  in  the  formative  period 
and  when  the  delicate  balance  between  the  right 
road  and  the  wrong  one  is  so  easily  turned.  Let 
every  young  man  carefully  take  account  of  his 
present  status  in  this  matter,  and  resolve  to  so 
place  himself  in  relation  to  morality  and  the 
trend  of  his  habits  that  his  future  may  be  secure 
in  the  fulfilment  of  all  that  is  best  and  most 
worth  attaining  in  life. 

Honesty  of  Purpose. — Another  concomitant 
adjunct  to  success  in  practice  is  the  demonstra- 
tion to  the  patient  of  an  absolute  honesty  of  pur- 
pose in  everything  that  is  done.  A  firm  convic- 
tion of  what  is  just  and  equitable  to  both  patient 


WINNING    PATRONAGE  37 

and  operator  should  form  the  basis  of  every-day 
practice,  and  the  dentist  should  early  seek  to 
establish  confidence  among  his  patients  by  a  rigid 
adherence  to  a  policy  which  has  for  its  ground- 
work the  principle  of  eternal  right.  If  a  man  has 
in  his  very  soul  the  essence  of  a  basic  honesty, 
he  does  not  need  to  tell  his  patrons  that  he  is 
honest.  They  will  know  it  without  the  telling. 
The  fact  will  shine  through  his  every  action, 
and  will  so  illuminate  his  professional  pathway 
that  people  will  be  intuitively  drawn  to  him. 
When  a  man  once  establishes  the  reputation  for 
rigid  honesty  he  is  more  than  half  armed  against 
dissension  and  misunderstanding.  If  a  differ- 
ence of  opinion  arises  between  a  practitioner 
and  his  patient,  the  question  as  to  whether  or 
not  the  practitioner  is  really  honest  is  one  of  the 
first  w^hich  enters  the  mind  of  the  patient.  And 
if  the  dentist  is  known  to  be  honest,  his  con- 
tention is  invariably  respected,  even  though  the 
patient  may  not  agree  with  him  in  opinion. 

This  matter  of  honesty  relates  as  much  to  the 
details  of  the  work  performed,  the  pains  taken 
with  each  operation,  the  character  of  the  opera- 
tion, the  best  judgment  as  to  what  shall  or  shall 


38  SUCCESS   IN   PRACTICE 

not  be  done  in  a  given  case,  and  the  advice  upon 
matters  with  which  the  patient  is  not  famihar, 
as  it  does  to  questions  of  finance  or  the  purely 
business  phase  o£  practice.  In  other  words,  the 
dentist  should  be  professionally  honest  as  well 
as  commercially  so. 

The  mere  fact  of  honesty  is  an  element  of  im- 
mense strength  to  a  man  in  any  walk  of  life. 
The  man  who  is  fundamentally  and  profoundly 
honest  need  not  be  afraid  of  any  other  man  or 
combination  of  men,  and  usually  he  is  not.  Hon- 
esty begets  confidence,  and  confidence  is  the  key- 
note to  attainment.  Unless  a  dentist  has  con- 
fidence he  cannot  expect  to  succeed.  It  is  only 
through  confidence  in  himself  that  he  can  inspire 
confidence  on  the  part  of  others,  and  he  should 
most  assiduously  cultivate  this  element  in  his 
character.  It  is  hardly  necessary  to  state  in  this 
connection  that  there  is  a  vast  distinction  be- 
tween an  honest  confidence  and  a  vulgar  self- 
conceit,  though  many  a  young  man  would  seem 
to  confuse  the  two.  Self-conceit  undermines 
and  belittles,  confidence  builds  up  and  magnifies. 
Confidence  is  cumulative,  strong,  and  psychic  in 
its  influence,  and  there  is  scarcely  any  other  one 


WINNING  PATRONAGE 


39 


element  so  potent  as  this  in  the  successful  build- 
ing of  a  dental  practice. 

Punctuality  and  System. — The  virtue  of  punc- 
tuality and  system  must  also  be  emphasized  in 
considering  the  requisites  necessary  for  success 
in  professional  life.  The  man  who  conducts  his 
practice  in  a  hap-hazard  way  will  have  hap- 
hazard results,  and  such  a  man  will  usually  be 
the  first  to  wonder  why  he  does  not  succeed. 
There  is  a  reason  for  everything  in  this  world; 
and  if  a  man  fails  in  life,  there  is  some  reason 
for  it.  It  is  only  for  the  one  who  fails,  to  search 
out  the  cause  of  his  failure,  and  then  resolutely 
set  himself  to  work  to  correct  the  fault,  no 
matter  at  what  cost  of  determination  and  perse- 
verance. This  last  statement  would  seem  to  im- 
ply that  the  causes  of  a  man's  failure  must  neces- 
sarily be  found  connected  with  the  man  himself, 
and  this  is  not  merely  an  assumption,  but  a  fun- 
damental and  most  profound  fact. 

Many  a  promising  dentist  has  thrown  away  a 
rare  chance  of  success  by  lack  of  punctuality  and 
S3'-stem.  In  this  age  of  intense  activity  in  mate- 
rial pursuits  the  value  of  time  becomes  an  im- 
portant element  in  the  conduct  of  one's  affairs. 


40  SUCCESS  IN  PRACTICE 

and  no  patient  of  any  consequence  will  continue 
to  patronize  a  dentist  who  does  not  economize 
time  by  being  systematic.  If  a  piece  of  work 
is  promised  at  a  certain  time,  the  dentist  should 
make  it  a  rule  to  have  it  done  at  that  time.  The 
necessity  for  constantly  apologizing  on  account 
of  lapses  in  this  regard  invariably  weakens  the 
hold  a  dentist  has  on  his  patients  and  destroys 
the  confidence  they  have  in  his  general  integrity. 
There  is  nothing  so  demoralizing  as  to  find  a 
man  careless  of  his  word  or  his  promise.  When 
an  appointment  is  made  with  a  patient  for  a  cer- 
tain hour,  it  should  be  the  aim  of  the  dentist  to 
be  ready  for  the  patient  at  the  appointed  time  if 
at  all  possible.  Of  course  in  a  professional  pur- 
suit where  the  relief  of  pain  is  the  paramount 
duty  emergencies  will  arise  which  sometimes  de- 
lay the  practitioner  beyond  the  time  set,  but  these 
are  only  occasional  and  are  easily  explained  and 
readily  understood  by  the  patient.  This  ques- 
tion of  appointments  will  be  considered  in 
greater  detail  in  a  subsequent  chapter. 

Knowledge  of  Human  Nature.  —  Above  all 
things  else,  to  be  a  successful  dentist  a  man  must 
be  a  close  student  of  human  nature.     I  have 


WINNING   PATRONAGE  4I 

already  said  that  the  chief  requisite  for  success  in 
the  practice  of  dentistry  is  efficiency, — in  other 
words,  that  to  be  successful  a  dentist  must  be 
skilful, — and  this  statement  still  holds  good.  But 
I  have  also  tried  to  show  that  there  are  other 
requisites  aside  from  mere  skill  which  enter  ma- 
terially into  success,  and  of  all  of  these  I  know 
of  none  more  essential  than  this  matter  of  study- 
ing- the  characteristics  and  temperaments  of  pa- 
tients. To  be  perfectly  and  completely  a  master 
of  his  environment  the  dentist  should  be  able  to 
read  like  an  open  book  every  man  or  woman 
who  comes  into  his  office.  And  this  can  be  ac- 
complished by  study, — a  kind  of  study  which 
really  becomes  the  most  fascinating  and  most 
profitable  of  all  pursuits.  To  do  this  a  dentist 
must  come  in  contact  with  people  as  widely  as 
possible,  and  he  must  cultivate  to  the  highest 
degree  the  power  of  observation.  No  act  or 
movement  or  impulse  of  any  individual  should 
escape  him;  and  without  in  the  least  degree 
being  impertinent  or  obtrusive  he  should  try  to 
fathom  the  motive  which  prompts  people  to  act. 
This  one  great  fundamental  fact  of  motive  is  the 
key  which  unlocks  many  a  hidden  mystery  of 


42 


SUCCESS  IN   PRACTICE 


human  action  and  makes  dear  what  would 
otherwise  appear  paradoxical  in  an  individual. 
No  two  people  can  be  successfully  managed  by 
the  same  methods,  and  in  scarcely  any  pursuit — 
with  the  possible  exception  of  medicine — is  the 
ability  to  read  human  nature  more  important 
than  in  dental  practice.  A  quick  intuition  of  the 
temperament,  the  whims,  the  prejudices,  the 
fancies,  and  the  peculiarities  of  individuals  is  a 
wonderful  talisman  in  the  management  of  a 
practice,  and  the  man  who  has  successfully  cul- 
tivated this  has  gone  much  farther  than  half  way 
towards  making  his  affairs  run  smoothly  and 
satisfactorily. 

The  intimation  is  not  here  intended  that  a 
dentist  should  be  at  all  cringing  or  subservient 
to  the  petty  caprices  or  unreasoning  domination 
of  those  who  seek  his  services,  but  merely  that 
he  should  have  the  tact,  based  on  his  knowledge 
of  temperament,  to  so  manage  his  patients  that 
he  can  win  their  confidence  and  subsequently 
their  full  control.  You  cannot  control  patients 
till  you  have  their  confidence,  and  you  cannot 
gain  their  confidence  till  you  understand  them. 
This  study  of  human  nature  is  most  broadening 


WINNING   PATRONAGE  43 

in  its  influence,  and  it  is  prolific  of  great  good 
aside  from  the  mere  advantage  it  presents  in  a 
practical  way. 

It  may  not  be  clear  to  all  as  to  just  what 
is  meant  by  the  suggestion  to  handle  patients 
differently  on  the  basis  of  a  knowledge  of  their 
varying  moods  and  temperaments,  but  a  single 
illustration  will  suffice  to  indicate  the  meaning. 
A  business-man  whose  time  is  valuable,  who  has 
vast  interests  at  stake,  and  who  is  not  much 
given  to  speech  may  apply  for  an  appointment. 
What  that  man  wants  is  to  have  his  dental  work 
done  in  the  most  expeditious  manner  and  with 
the  fewest  possible  words.  He  does  not  come  to 
the  office  to  visit  or  gossip.  Every  unnecessary 
remark  made  by  the  dentist  is  just  so  much  waste 
time  to  him,  and  he  naturally  resents  personali- 
ties or  trivial  talk  of  any  kind.  A  gentlemanly 
"  Good-morning.  Please  be  seated,"  and  a 
prompt  and  business-like  approach  to  the  work 
in  hand  appeals  to  him  at  once.  An  operation 
may  often  be  performed  for  such  a  man  with 
scarcely  a  word  from  beginning  to  end, — the  en- 
tire attention  and  energy  of  the  operator  being 
concentrated  on  the  work  rather  than  on  any- 


44  SUCCESS   IN   PRACTICE 

thing  of  a  conversational  nature.  To  a  man 
like  this  any  casual  remark — even  that  connected 
with  the  nature  of  the  work  being  done — is  a 
needless  distraction  which  diverts  from  the  main 
purpose  of  the  sitting  and  steals  so  much  of  his 
time.  The  fewer  words  the  better  with  such  a 
man,  and  anything  aside  from  the  ordinary  cour- 
tesies of  salutation  and  dismissal  is  uncalled  for. 
It  is  all  business  with  him,  there  is  little  of  the 
social  element  in  his  make-up,  and  what  small 
percentage  there  may  be  does  not  find  the  proper 
environment  for  its  display  in  a  dental  office. 
You  can  gain  that  man's  respect  and  favor  more 
by  what  you  leave  unsaid  than  by  anything  you 
can  say.  It  is  the  doing  he  wants, — the  doing 
promptly  and  without  any  fussiness. 

On  the  other  hand,  there  are  some  individuals 
who  are  so  socially  inclined  that  they  must  talk 
and  be  talked  to.  The  dental  office  is  of  course 
not  the  place  for  visiting  or  shop-talk  or  gossip 
of  any  kind.  It  should  not  be  made  the  clearing- 
house of  all  the  petty  scandal  of  the  community ; 
and  yet  it  must  not  be  turned  into  a  monastery 
or  a  bear's  den.  People  must  be  courteously  re- 
ceived, and  some  of  them  must  be  more  or  less 


WINNING    PATRONAGE  45 

entertained  while  there.  Certain  individuals  are 
so  cheery  and  friendly  in  temperament  that  the 
dentist  must  himself  take  on  an  air  of  cheeriness 
and  friendliness  in  dealing  with  them.  To  carry 
an  individual  of  this  character  through  an  opera- 
tion in  the  same  brusque  fashion  demanded  by 
the  reserved  business-man  just  referred  to  would 
be  simple  barbarity.  It  is  necessary  with  some 
patients  during  an  operation  to  make  more  or 
less  of  a  running  commentary  on  the  work  as  it 
is  being  done.  The  mere  fact  of  conversation 
is  to  them  a  wonderful  relief  of  tension;  and 
while  they  may  be  so  situated  with  appliances  in 
the  mouth  that  they  cannot  well  talk  themselves, 
the  carefully  modulated  and  sympathetic  voice  of 
the  operator  encouraging  them  in  trying  periods 
of  the  work  has  a  sustaining  influence  which 
must  not  be  overlooked. 

It  should  of  course  ordinarily  be  the  aim  of 
the  operator  to  proceed  with  his  work  with  as 
little  waste  of  words  as  possible,  and  he  should 
invariably  discourage  by  example  too  much 
talking  during  an  operation.  The  concentra- 
tion of  energ}^  necessary  to  accomplish  the  best 
results  —  particularly  where  intricate  work  is 


46  SUCCESS  IN   PRACTICE 

being  done — is  always  disturbed  and  the  har- 
mony of  results  marred  by  frequent  diversions 
of  speech;  and  yet  with  patients  of  the  tem- 
perament just  indicated  a  certain  amount  of 
talking  is  necessary,  not  only  for  the  pleasure  it 
gives  the  patient  but  for  its  quieting  influence 
during  an  operation. 

This  is  only  one  of  many  ways  in  which  a 
quick  intuition  of  temperament  may  be  made  to 
do  service  in  the  management  of  patients.  A 
constant  display  of  tact  and  delicacy,  the  ad- 
vantage to  be  taken  of  certain  moods  and  fan- 
cies, the  ability  to  say  the  right  word  at  the  right 
time,  and  particularly  to  avoid  saying  the  wrong 
word,  all  of  these  embodied  in  an  intricate  and 
intimate  knowledge  of  human  nature  will  at 
once  place  the  dentist  in  possession  of  the  power 
to  solve  many  of  the  difficult  problems  to  be  en- 
countered in  conducting  a  dental  practice. 

Essentials  to  Success  can  be  Cultivated. — In 
thus  briefly  enumerating  the  various  essentials 
to  success  it  will  be  noted  that  the  original 
proposition  to  the  effect  that  these  requisites 
were  for  the  most  part  of  a  character  that  could 
be  cultivated  by  persons  of  average  ability  still 


WINNING   PATRONAGE 


47 


holds  g-ood.  A  man  cannot  necessarily  become 
a  successful  dentist  by  merely  wishing  to  be,  but 
he  can  attain  to  any  of  the  essentials  of  success 
by  application.  It  is  the  steady,  sturdy  plodder 
who  wins  in  the  end ;  and  any  young  man  with 
a  taste  for  dentistry  can  assuredly  win  success 
if  he  only  applies  himself.  The  best  message 
that  can  be  sent  out  under  this  head  is  summed 
up  in  the  one  term — application.  Without  this 
no  man  can  succeed  in  any  calling,  least  of  all  in 
dentistry. 


Ill 

LOCATION 

The  question  of  selecting  a  location  is  an  im- 
portant consideration  for  a  young  dentist.  The 
choice  between  a  country  town  and  a  large  city 
always  comes  up  for  decision,  as  also  does  fre- 
quently the  matter  of  locating  in  one's  native 
place.  Unless  the  young  graduate  has  had  some 
grounding  in  the  management  of  the  public  and 
has  some  financial  backing,  he  would  probably 
better  locate  at  first  in  a  smaller  place,  because 
of  the  lesser  responsibility  and  expense  and  the 
opportunity  it  gives  him  to  study  his  capabilities 
and  learn  his  limitations  in  practice.  Few  young 
men  have  an  adequate  idea  of  how  much  they 
still  have  to  learn  after  graduating,  and  this 
training  in  the  conduct  of  a  country  practice  will 
prove  of  inestimable  value,  even  though  they 
eventually  intend  to  seek  a  large  city.  There 
are  very  many  things  to  be  said  in  favor  of  the 

country  town  as  a  place  of  permanent  practice, 
48 


LOCATION 


49 


and  most  of  them  apply  with  double  force  to 
the  young  man  just  starting  out.  He  can  more 
rapidly  widen  his  acquaintance  and  can  come 
personally  into  contact  with  a  larger  number  of 
prospective  patrons  than  he  can  hope  to  do  in  a 
city.  If  his  practice  falls  off  at  times,  he  will 
not  be  immediately  swamped  by  high  rent  and 
other  corresponding  expenses. 

There  are  two  chief  drawbacks  to  a  small 
place,  one  of  which  is  really  of  no  consequence, 
though  it  usually  seems  like  a  mountain  to  the 
over-sensitive  young  man,  while  the  other  may 
be  considered  a  real  objection.  The  first  is  the 
element  of  petty  gossip  so  prevalent  in  small 
towns  where  people  meet  daily  and  almost 
hourly  in  conversational  intercourse,  and  where 
the  insignificant  things  of  life  are  threshed  over 
and  over  in  the  absence  of  matters  of  greater 
moment.  The  ancient  if  not  venerable  Mrs. 
Grundy — that  past-mistress  in  the  gentle  art  of 
annoying  people — almost  invariably  takes  up  her 
blessed  abode  in  the  environs  of  a  village  or 
smaller  town,  and  usually  manages  to  make  it 
interesting  for  the  young  men  and  maidens  of 
the  place.     Her  especial  prey  is  the  new-comer, 

4 


50 


SUCCESS   IN   PRACTICE 


and  woe  betide  the  sensitive  youth  who  allows 
himself  to  be  annoyed  by  her  prattle.  The  ex- 
tent of  injury  she  is  able  to  work  upon  him  is 
gauged  solely  by  the  nature  of  his  attitude  to- 
wards her.  If  he  is  irritated  or  chagrined  or 
disturbed  by  her  gossip,  then  he  is  to  that  degree 
injured;  but  that  she  can  ever  do  him  serious 
harm  aside  from  this  has  never  yet  been  demon- 
strated. One  of  the  first  things  a  young  dentist 
should  do  in  going  to  a  strange  town  is  to  re- 
solve to  live  an  upright,  manly  life  entirely  above 
reproach,  and  then  to  pay  no  attention  to  the 
brigade  of  petty  gossip-mongers.  If  he  does  this 
they  will  soon  let  him  alone. 

The  other  objection  to  a  small  town  is  the 
professional  isolation.  The  constant  association 
of  men  of  his  own  calling  is  really  of  the  greatest 
importance  to  a  young  man  in  the  development 
of  a  well-rounded  professional  life,  and  lacking 
this  he  is  too  often  inclined  to  drift  away  from 
high  professional  ideals  and  to  lose  the  inspira- 
tion which  comes  only  from  contact  with  the 
thinking  men  of  his  profession.  In  the  city  he 
has  the  advantage  of  frequent  society  meetings, 
and  this  is  a  great  source  of  help  to  him  at  a 


LOCATION 


51 


critical  period  of  his  career.  But  the  country 
dentist  need  not  by  any  means  be  entirely  de- 
prived of  professional  association.  There  is 
always  his  State  society,  with  possibly  others  at 
convenient  distance,  and  then  the  dental  jour- 
nals, if  conscientiously  read,  will  keep  him  in 
close  touch  with  the  progress  of  the  profession, 
so  that  he  will  not  entirely  lose  the  spirit  of  true 
professionalism. 

There  is  one  argument  in  favor  of  starting  in 
a  small  town  and  subsequently  moving  to  a 
larger  place  which  relates  particularly  to  the 
probability  of  numerous  mistakes  being  made 
by  the  young  practitioner  in  the  early  days  of 
his  practice.  It  is  difficult  for  the  beginner  to 
avoid  making  mistakes,  many  of  them  of  a  na- 
ture that  the  older  practitioner  readily  escapes; 
and  it  is  frequently  the  bitter  dr^s  from  this 
crucible  of  early  experiences  which  load  a  young 
man  down  and  cling  to  him  to  his  detriment 
long  after  he  has  attained  sufficient  perfection  to 
avoid  making  mistakes  of  a  similar  nature.  This 
incubus  sometimes  casts  a  shadow  over  his  ca- 
reer in  the  town  where  the  mistakes  were  made, 
and  it  is  frequently  a   fortunate  circumstance 


52  SUCCESS   IN   PRACTICE 

which  takes  the  young-  man  away  from  such  an 
environment  and  places  him  where  he  can  begin 
hfe  anew,  armed  with  the  superior  knowledge 
which  his  experience  has  given  him.  While  on 
general  principles  it  is  bad  policy  to  move  fre- 
quently, it  may  yet  be  the  very  best  policy  to 
move  once  and  leave  mistakes  behind.  Not  that 
a  man  will  ever  get  over  making  mistakes,  but 
that  many  of  those  incident  to  early  experience 
need  not  be  made  later  on. 

As  to  a  young  man  locating  in  a  town  where 
he  has  grown  up,  the  arguments  are  largely  in 
its  disfavor.  The  just  distinction  between  a 
harum-scarum  boy  going  to  school  and  a  digni- 
fied professional  man  conducting  a  practice  is 
too  great  to  be  realized  by  the  average  commu- 
nity as  existing  in  the  same  individual,  and  if  a 
young  man  starts  practice  in  his  native  place 
the  people  are  too  likely  to  look  upon  the  newly- 
fledged  dentist  as  only  a  very  slight  remove  from 
the  tow-headed  boy,  and  are  accordingly  slow 
to  admit  him  to  a  dignified  standing  in  the  com- 
munity. They  find  it  difficult  to  leave  off  calling 
him  "  Jack"  or  "  Billy"  or  "  Pete,"  and  when  it 
comes  to  calling  him  "  Doctor"  they  blush  for 


LOCATION  53 

his  impertinence  in  assuming  such  a  title.  But 
let  this  same  apparent  young  upstart  go  to  a 
strange  town,  and  he  gets  his  title  as  the  natural 
order  of  things,  and  without  any  hesitation  on 
the  part  of  the  people. 

It  is  true  that  the  mere  fact  of  calling  a  man 
"  Doctor"  does  not  insure  his  success  in  prac- 
tice; but  in  order  to  command  proper  respect 
as  a  professional  man  the  dentist  should  carry 
with  him  a  certain  degree  of  dignity  which  can- 
not well  be  attained  in  the  face  of  too  much 
familiarity.  Then  again,  to  begin  practice  among 
the  people  with  whom  one  has  grown  up  in- 
volves a  difficulty  in  maintaining  good  business 
relations.  There  is  always  the  expectancy  on 
the  part  of  those  who  apply  for  services  that 
there  shall  naturally  be  some  favoritism  on  the 
ground  of  old  acquaintanceship.  It  is  better  to 
establish  a  practice  among  strangers  and  turn 
the  patients  into  friends  than  to  begin  with 
friends  and  attempt  to  turn  them  into  satisfac- 
tory patients. 


IV 

EXTENDING   ACQUAINTANCE 

When  a  young  man  locates  in  a  place  it  be- 
comes necessary  to  extend  his  acquaintance  as 
widely  as  possible  along  legitimate  lines  in  order 
to  rapidly  gain  patronage.  If  he  goes  a  stranger 
into  a  town,  or  even  into  a  city,  it  is  always  de- 
sirable to  take  letters  of  introduction  to  the  influ- 
ential people  of  the  place.  The  first  move  he 
makes  is  very  important,  particularly  with  regard 
to  the  character  of  the  people  he  meets.  He 
should  aim  to  cultivate  good  society  at  the  out- 
set, not  necessarily — and  often  not  preferably — 
the  swell  set,  but  people  of  good  moral  and  busi- 
ness standing. 

Letters  of  Introduction. — In  presenting  a  let- 
ter of  introduction  the  young  man  should  exer- 
cise great  care  not  to  prejudice  his  case  by 
consuming  too  much  of  the  recipient's  time. 
Usually  men  or  women  worth  meeting  have 
many  demands  on  their  time,  and  if  a  young 
man  approaches  such  an  individual  without  due 
54 


EXTENDING  ACQUAINTANCE  55 

regard  for  this  fact,  he  is  quite  likely  to  prove 
a  bore.  Let  him  present  his  letter  in  a  busi- 
ness-like way,  stating  that  he  is  desirous  of 
making  their  acquaintance,  but  that  he  does 
not  wish  to  waste  their  time.  He  can  readily 
gather  from  the  nature  of  the  answer  he  receives 
just  how  much  leeway  he  has  in  this  particular, 
and  can  govern  himself  accordingly.  Usually 
people  of  the  right  sort  are  glad  to  welcome  new- 
comers to  a  town ;  and  if  the  young  man  makes 
a  favorable  impression  at  the  outset,  it  is  not  a 
difficult  matter  to  extend  his  acquaintance. 
After  he  has  met  a  dozen  people  in  the  place, 
his  success  from  that  time  forward  depends  on 
himself.  He  should  beware  of  boasting  too  much 
about  what  he  proposes  to  accomplish  in  the 
way  of  practice,  particularly  if  he  goes  to  a 
place  where  there  is  already  a  dentist,  but  he 
must  at  all  times  preserve  an  air  of  quiet  con- 
fidence that  he  will  succeed.  The  unobtrusive 
self-assurance  that  he  has  within  him  the  certain 
elements  of  success,  the  constant  conviction  that 
he  must  win,  no  matter  what  obstacles  are  placed 
in  his  path,  this  of  itself  is  a  potent  factor  in 
carrying  a  young  man  to  success.    No  man  ever 


56  SUCCESS   IN   PRACTICE 

yet  accomplished  great  things  through  the  me- 
dium of  despondency.  Let  the  young  man  place 
the  most  promising  construction  on  his  prospects, 
but  let  him  do  it  in  such  a  way  as  not  to  give 
offence.  A  vulgar  display  of  conceit  always  en- 
genders distrust  and  reacts  against  the  indi- 
vidual, but  an  attitude  of  calm  assurance  backed 
up  by  steady  application  creates  confidence  and 
more  than  half  wins  the  battle. 

The  First  Patient. — The  first  patient  a  young 
man  puts  in  his  chair  for  professional  services 
should  mark  an  event  in  his  life.  No  matter 
how  humble  in  position  or  circumstances  this 
patient  may  be,  the  dentist  should  seek  to  make 
a  favorable  impression.  In  fact,  in  the  manage- 
ment of  each  individual  who  applies  to  him  the 
aim  should  invariably  be  to  so  treat  the  patient 
that  it  will  result  in  the  sending  of  other  patients. 
The  recommendation  of  an  individual  who  has 
been  in  the  hands  of  a  dentist  counts  for  more 
than  any  other  kind  of  advertising,  and  it  has  the 
advantage  that  this  is  legitimate  advertising. 
Show  each  patient  that  you  have  a  vital  interest 
in  his  or  her  welfare  and  that  your  relationship 
with  the  public  is  different  from  that  of  a  trades- 


EXTENDING   ACQUAINTANCE  57 

man.  Advise  the  patient  always  for  what  you 
believe  to  be  the  best,  irrespective  of  your  own 
financial  relation  to  the  matter,  and  when  the 
fact  that  you  do  this  becomes  known,  as  it  surely 
must,  it  will  prove  a  strong  tie  to  bind  people  to 
you. 

The  dentist  should  early  seek  to  establish  a 
community  of  interest  between  the  patient  and 
himself,  so  that  their  relationship  becomes  some- 
thing more  than  a  mere  barter  of  money  for 
professional  services.  He  who  develops  an 
abiding  friendship  between  himself  and  those 
who  come  to  his  office  will  never  lack  for 
patients,  and  some  of  the  most  cherished  associa- 
tions of  a  lifetime  may  be  made  in  this  way. 

Social  Functions. — Extending  acquaintance 
through  the  medium  of  social  functions  is  a  per- 
fectly proper  thing  to  do,  though  the  young  man 
should  have  a  care  not  to  deport  himself  in  such 
a  w^ay  as  to  raise  the  suspicion  that  he  is  trying 
to  advertise  his  profession.  In  fact,  there  is 
nothing  more  lacking  in  good  form  than  the 
habit  of  talking  shop  at  a  social  gathering.  Aim 
to  be  cordial  and  pleasant  with  everybody,  so 
that  people  are  attracted  to  you  by  virtue  of  your 


58  SUCCESS   IN   PRACTICE 

personality.  There  is  no  other  quality  so  win- 
ning in  society  as  that  of  invariably  being  a  per- 
fect gentleman,  and  this  is  something  a  young 
man  can  acquire  by  a  close  study  of  what  is  con- 
sidered good  form.  The  prime  requisite  for 
success  in  society  is  a  never-failing  and  genuine 
courtesy.  This  will  win  where  mere  flashiness, 
either  of  apparel  or  wit,  will  fall  short  of  per- 
manent success. 

If  a  young  man  draws  people  to  him  by  virtue 
of  his  inherent  qualities  of  sturdy  manhood  and 
uniform  good  will  in  society,  they  will  naturally 
inquire  into  his  calling,  and  the  next  step  to  that 
of  their  patronage  is  easy.  But  there  is  one 
feature  of  this  that  requires  careful  considera- 
tion. It  is  better  always  that  people  should  not 
become  personally  too  friendly  or  familiar  with 
the  dentist,  for  the  reason  that  in  the  proper 
conduct  of  a  practice  there  are  always  certain 
requirements  which  the  dentist  must  demand  of 
the  patient  and  to  which  the  patient  if  approached 
on  a  strictly  professional  basis  will  graciously 
accede,  but  which  if  the  dentist  is  a  close  per- 
sonal friend  will  not  be  so  likely  to  be  considered 
obligatory.     In  other  words,  it  is  more  difficult 


EXTENDING    ACQUAINTANCE  59 

to  establish  legitimate  professional  discipline 
with  a  friend  than  with  a  stranger.  The  one 
matter  of  appointments  will  serve  as  an  illustra- 
tion of  what  is  meant.  It  is  necessary  for  the 
dentist,  in  order  to  profitably  occupy  his  time,  to 
arrange  for  his  work  on  appointment,  and  it  is 
to  him  a  question  of  considerable  moment  that 
appointments  be  kept  punctually.  With  a 
stranger  this  is  quickly  recognized  and  abided 
by,  but  an  intimate  friend  is  quite  likely  to 
ignore  his  obligation  on  the  ground  of  famili- 
arity and  to  presume  on  his  friendship  with  the 
dentist  for  all  kinds  of  laxity.  As  has  already 
been  said,  it  is  better  to  obtain  patients  among 
strangers,  and  then  when  they  have  become 
familiar  with  the  business  methods  of  the  dentist 
they  will  not  depart  from  those  methods  and  can 
safely  be  made  into  close  personal  friends. 

The  Church. — The  church  is  often  used  as 
a  means  through  which  to  extend  acquaintance, 
and  under  certain  circumstances  it  is  a  perfectly 
legitimate  medium.  The  close  personal  relation- 
ship of  the  members  of  a  church  and  the  fre- 
quency with  which  they  meet  each  other  all  tend 
to  favor  the  rapid  spread  of  personal  acquaint- 


6o  SUCCESS  IN   PRACTICE 

anceship,  and  there  is  quite  naturally  a  bond  of 
common  sympathy  arising  from  mutual  aims  and 
interests  which  links  the  members  together  more 
closely  than  under  ordinary  associations  of  life. 
To  fall  in  with  this  in  a  natural  way  on  the  part 
of  a  man  who  is  at  heart  a  sincere  professor  of 
religion  and  whose  proper  place  is  found  in  the 
church  is  well  and  good.  There  can  be  no  criti- 
cism of  this;  and  if  a  young  man  creates  ac- 
quaintance under  these  conditions  he  may  honor- 
ably find  it  of  benefit  to  him  in  a  business  way. 
But  there  is  nothing  in  all  the  category  of 
professional  meanness  which  can  compare  in  the 
slightest  degree  with  an  effort  to  use  the  church 
as  a  medium  of  securing  practice  on  the  part  of 
a  man  who  otherwise  has  no  interest  in  it.  To 
pose  as  a  church-going  man  or  as  one  who  has 
religious  motives  by  an  individual  whose  only 
aim  is  to  further  his  business  ventures  is  the 
basest  of  all  perfidy  and  should  entitle  him  to 
the  hearty  contempt  of  every  one.  Hypocrisy  is 
bad  enough  in  any  relation  in  life,  but  hypocrisy 
which  uses  the  church  as  a  cloak  behind  which 
to  build  up  worldly  interests  is  absolutely  be- 
yond the  pale  of  decency  or  tolerance.     Unless 


EXTENDING   ACQUAINTANCE  6 1 

the  young  man  has  religious  instincts,  or  can  go 
to  church  with  pure  motives  for  the  purpose  of 
receiving  mutual  or  moral  benefit,  he  would  bet- 
ter stay  away;  or  if  he  desires  to  go  as  a  means 
of  social  enjoyment,  let  him  at  least  avoid  as- 
suming a  sanctimonius  air  or  taking  any  promi- 
nent part  in  the  functions  of  the  church.  In 
other  words,  let  him  avoid  hypocrisy  or  deceit. 
No  matter  how  successful  a  man  may  seem  to  be 
at  this  kind  of  game  for  a  time,  his  sins  will 
surely  find  him  out,  and  his  ultimate  portion 
will  be  contempt  and  distrust  on  the  part  of  the 
people.  Even  if  he  could  succeed  in  deceiving 
the  people,  and  thereby  secure  their  patronage, 
there  is  always  behind  every  hypocritical  act  a 
corresponding  disintegration  of  character  in  the 
individual  himself  which  ultimately  will  under- 
mine the  strongest  personality  and  defeat  the 
shrewdest  aims. 

Let  the  young  man  be  honor-bright  in  every 
relation  of  life,  but  particularly  let  him  avoid 
trafficking  w'ith  things  so  sacred  as  the  religious 
convictions  of  the  community  in  which  he  lives. 
I  would  rather  cope  with  an  open-handed  devil 
any  time  than  trust  for  one  moment  the  fawning 


62  SUCCESS   IN   PRACTICE 

pretence  of  a  sanctimonious  hypocrite.  Perma- 
nent success  never  yet  came  from  following  un- 
worthy methods,  and  of  all  of  these  methods 
none  is  more  detestable  than  the  one  of  working 
the  church  for  professional  purposes. 


MANAGING   PATIENTS 

The  Management  of  Children. — To  be  suc- 
cessful in  the  management  of  children  means  a 
great  deal  in  the  maintenance  of  a  satisfactory 
and  permanent  practice.  The  children  of  to-day 
make  the  patients  of  a  few  years  hence,  and  if  a 
practitioner  has  the  tact  and  patience  to  control 
children  from  the  time  they  first  come  to  him 
till  they  grow  to  years  of  accountability  he  can 
then  have  a  class  of  practice  built  upon  the  lines 
of  his  own  choosing  and  of  a  character  to  har- 
monize best  with  his  individual  preference. 
There  is  nothing  more  interesting  in  life  than  to 
watch  the  development  of  a  child  and  study  the 
various  manifestations  of  character-building  as 
exemplified  in  their  attitude  towards  one  with 
whom  they  are  brought  into  such  close  relation- 
ship as  the  dentist.  Child-study  is  always  in- 
structive, and  it  is  doubly  so  when  conducted 
from  the  point  of  view  of  a  professional  associa- 

63 


64  SUCCESS   IN   PRACTICE 

tion.  The  dentist  should  early  aim  to  under- 
stand his  little  patients,  to  gain  their  confidence 
and  enlist  their  sympathy  with  whatever  he  at- 
tempts to  accomplish  for  them.  If  he  really 
loves  children  and  always  treats  them  in  a  frank 
and  cordial  manner,  he  will  in  turn  receive  at 
their  hands  a  reciprocal  attachment  which  event- 
ually will  prove  one  of  the  greatest  inspirations 
to  high  professional  endeavor.  The  implicit  con- 
fidence of  a  child  is  no  small  thing  to  attain,  and 
he  who  has  this  is  not  altogether  bereft  of  satis- 
faction in  the  conduct  of  his  affairs. 

The  first  thing  a  dentist  must  learn  in  the 
management  of  children  is  not  to  deceive 
them.  He  should  aim  to  avoid  giving  pain  to 
a  child  whenever  possible;  but  if  it  is  found 
necessary  to  inflict  pain  in  an  operation,  the 
child  should  never  be  promised  that  there  will 
be  no  pain.  The  magnitude  of  the  hurt  must  of 
course  not  be  exaggerated  in  advance.  In  fact, 
it  is  best  ordinarily  to  make  light  of  it  and  place 
the  best  possible  construction  on  it.  It  is  usually 
well  to  say  to  the  child  that  the  dentist  cannot 
always  tell  precisely  whether  an  operation  will 
hurt  or  not,  but  that  if  it  does  hurt  a  little,  the 


MANAGING   PATIENTS  65 

child  may  be  sure  that  the  dentist  will  be  very 
careful  about  it  and  not  hurt  in  the  slightest 
degree  more  than  is  necessary.  But  to  promise 
that  it  shall  not  hurt,  and  thereby  gain  the  little 
patient's  consent  to  an  operation  which  in  the 
nature  of  it  must  give  pain,  is  an  abominable 
subterfuge  which  reacts  on  the  dentist  and  raises 
a  suspicion  in  the  child's  mind  which  subsequent 
years  are  powerless  to  efface.  Different  children 
require  different  methods  to  manage  them,  and 
with  some  especially  obstinate  and  unreasonable 
children  it  may  at  times  be  necessary  to  employ 
force  in  accomplishing  the  end,  but  ordinarily  a 
little  tact  will  win  the  day.  With  most  children 
an  adroit  appeal  to  their  manhood  or  woman- 
hood will  work  marvels.  The  child-mind  is 
wonderfully  susceptible  to  praise  and  encour- 
agement, and  a  word  which  touches  their  pride 
will  go  far  towards  nerving  them  up  to  an  oper- 
ation. 

No  attitude  should  ever  be  taken  towards  a 
child  except  one  of  extreme  kindness.  Even  if 
it  becomes  necessary  to  coerce  a  child  into  an 
operation,  it  should  be  done  in  the  kindliest  man- 
ner, and  never  with  a  display  of  temper;   and  if 

5 


66  SUCCESS   IN   PRACTICE 

an  issue  has  arisen  whereby  the  child  has  been 
compelled  to  submit  against  his  will,  the  dentist 
should  take  great  pains  to  so  soothe  his  feelings 
subsequently  by  a  kindly  encouraging  interest  in 
his  welfare  that  the  child  will  leave  the  office 
without  harboring  any  resentment.  It  is  some- 
times astonishing  how  a  stubborn  child  will  yield 
to  a  gentle  reasoning  and  a  cordial  show  of  kind- 
ness immediately  following  a  contention  in  which 
the  dentist  has  come  out  master  of  the  situation. 
Kindness  is  very  soothing  under  these  circum- 
stances, and  it  also  proves  to  the  child  that,  after 
all,  the  dentist  is  a  good  friend,  and  if  he  does 
hurt,  it  is  only  because  of  necessity  and  solely 
for  the  patient's  good. 

But  it  is  best  if  possible  to  avoid  giving  much 
pain  to  children.  Usually  palliative  measures 
are  preferable  wherever  they  can  be  made  effec- 
tive, particularly  till  the  little  patient  has  grown 
accustomed  to  coming  to  the  dentist  and  has 
been  led  up  by  a  skilful  system  of  management 
to  the  point  where  a  reasonable  amount  of  pain 
will  be  tolerated  without  protest.  The  first  visit 
of  a  child  to  a  dental  office  is  usually  a  mo- 
mentous occasion,  and  except  under  the  most 


MANAGING  PATIENTS  6/ 

urgent  necessity  no  pain  should  ever  be  given 
at  this  time.  The  child,  if  timid,  should  be 
entertained  by  the  dentist  in  such  a  way  that 
so  far  as  the  dentist  personally  is  concerned 
there  is  no  fear.  It  is  frequently  well  to  make 
the  first  examination  of  the  teeth  without  put- 
ting the  little  tot  in  the  dental  chair,  and  if  the 
child  is  very  young,  it  is  usually  best  to  have 
the  mother  or  nurse  hold  it  in  her  lap.  Then 
when  the  first  mere  glance  is  had  the  dentist 
should  say  something  complimentary  either  of 
the  teeth  or  of  the  patient,  and  if  the  child  is 
not  too  timid  he  should  pat  the  little  round  cheek 
in  a  friendly  way,  and  the  ice  is  broken  once 
for  all  so  far  as  that  child  is  concerned.  The 
gentle  touch  of  the  human  hand  has  a  wonderful 
effect  on  a  child,  and  a  demonstrated  tenderness 
on  the  part  of  the  dentist  at  this  first  visit  influ- 
ences largely  his  subsequent  success  with  the 
little  patient. 

It  is  sometimes  marvellous  what  children  will 
bear  in  the  way  of  pain  without  protest  if  perfect 
confidence  has  been  established  and  an  appeal  is 
made  to  their  pride.  A  case  in  point  is  worth 
recording  as  illustrative  of  what  may  be  accom- 


68  SUCCESS  IN   PRACTICE 

plished  with  an  apparently  wayward  child  by  a 
little  tact.  A  lady  walked  into  the  writer's  office 
one  day  leading  a  crying  child.  The  little  girl 
was  in  the  saddest  distress  imaginable,  and  the 
mother  was  out  of  sorts  and  irritated  by  the 
evident  contention  over  the  visit.  Said  the 
mother :  "  Doctor,  I  don't  know  whether  you 
can  do  anything  with  this  child  or  not ;  but  she 
has  worn  us  all  out  with  the  toothache,  and  I 
have  finally  forced  her  to  come  and  see  if  you 
can  stop  the  pain.  She  is  the  most  wayward 
child  I  ever  saw,  and  I  am  utterly  exhausted 
with  her." 

I  saw  at  a  glance  that  the  case  between  the 
mother  and  the  child  was  in  its  acute  stage, 
and  that  counter-irritation  was  not  indicated  for 
either.  I  approached  the  little  girl,  and  said, 
gently :  "  Well,  dearie,  let  me  see  what  the 
trouble  is."  Instantly  she  dropped  her  mother's 
hand  and  looked  up  at  me  with  such  an  ex- 
pression of  relief  and  confidence  on  that  little 
tear-stained  face  of  hers  that  I  said :  "  Why, 
bless  your  heart,  you  and  I  are  not  going  to  have 
any  difficulty,  are  we?" 

"  Well,"  the  mother  snapped  out,  impetuously, 


MANAGING   PATIENTS  69 

"  if  you  can  manage  her,  you  are  the  first  one  I 

ever  saw  who  could.    She's  the " 

But  I  stopped  her  with  a  gesture,  and  asked 
her  if  she  had  some  shopping  to  do  or  anything 
to  occupy  her  for  the  next  half-hour.  She  was 
quick-witted  enough  to  take  the  hint,  and  I  soon 
had  the  little  girl  to  myself  in  the  office.  The 
moment  the  mother  was  out  of  the  room  the 
tears  began  to  dry  and  the  sobbing  to  cease,  and 
in  a  very  few  minutes  the  little  patient  was 
perched  up  in  the  chair  showing  me  the  tooth 
that  ached.  She  was  one  of  those  delicate,  sensi- 
tive, high-strung  little  creatures,  susceptible  to 
kindly  treatment,  but  instantly  rebellious  against 
anything  harsh,  and,  unfortunately,  mother  and 
child  did  not  understand  each  other.  I  treated 
her  with  the  utmost  tenderness  and  managed  to 
relieve  the  pain  with  little  discomfort.  By  the 
time  the  mother  returned  she  was  the  cheeriest, 
brightest  little  midget  imaginable,  and  the 
mother  said :  "  Dear  me,  I  guess  you  have  hyp- 
notized her.  I  never  saw  her  take  to  any  one  like 
that  before."  I  told  her  that  all  the  hypnotism 
I  had  used  on  the  child  was  kindness,  and  I  even 
ventured  to  suggest  that  she  experiment  on  her 


70  SUCCESS   IN   PRACTICE 

little  daughter  in  the  same  way  and  watch  the 
result. 

It  became  necessary  to  have  many  sittings  with 
the  child  subsequently,  and  as  her  teeth  were 
extremely  sensitive,  some  of  these  sittings  were 
painful,  but  never  at  any  time  did  I  hear  a  pro- 
test from  her,  nor  was  she  ever  reluctant  to  take 
the  chair.  I  have  seen  her  sit  through  an  opera- 
tion when  at  times  the  tears  would  course  down 
her  cheeks,  and  my  only  answer  upon  expressing 
sympathy  for  her  was  a  bright  smile  bursting 
through  the  tears.  What  a  wonderous  mentality 
there  is  wrapped  up  in  a  sensitive  child,  and 
what  a  sacred  trust  it  is  for  those  to  whom  the 
care  of  such  children  is  committed  that  they 
study  carefully  the  myriad  mainsprings  of  mo- 
tive behind  every  act  and  thereby  learn  to  bring 
out  the  best  there  is  in  this  tiny  "  bundle  of 
possibilities." 

To  the  dentist  it  is  given  to  accomplish  great 
good  with  such  children  on  account  of  the  close 
relationship  existing  between  patient  and  prac- 
titioner; and  no  man  can  make  a  careful  and 
continued  observation  of  child-life  in  this  con- 
nection without  thereby  being  made  vastly  better 


MANAGING   PATIENTS  71 

himself.    The  results  will  repay  a  thousand  times 
for  the  effort. 

The  Management  of  Nervous  Patients. — Next 
to  children,  those  patients  who  are  nervous  or 
in  ill-health  require  more  diplomacy  to  manage 
than  any  other  class,  and  no  rule  or  set  of  rules 
can  be  made  to  apply  to  all  of  them.  They  vary 
so  in  their  freaks  and  fancies  that  it  is  a  matter  of 
constant  study  to  control  them,  and  yet,  in  view 
of  the  fact  that  they  are  often  in  need  of  dental 
service,  no  dentist  can  ever  be  in  the  highest 
degree  successful  unless  he  develops  sufficient 
tact  to  deal  with  them.  The  keynote  in  their 
management,  the  same  as  with  children,  is  kind- 
ness. Above  all  things  the  dentist  should  culti- 
vate a  gentleness  of  manner  and  a  sympathetic, 
well-modulated  tone  of  voice,  which  more  than 
anything  else  may  be  considered  effective  in 
gaining  their  confidence.  Patience  of  the  most 
sublime  type  is  also  required,  and  a  constant 
scrutiny  of  their  varying  moods  so  as  to  be  able 
to  adapt  one's  self  to  them.  On  approaching  the 
mouth  to  do  anything  for  such  patients  it  is 
essential  to  practise  the  utmost  delicacy  of  touch 
and  to  avoid  if  possible  giving  any  pain,  par- 


72 


SUCCESS   IN   PRACTICE 


ticularly  in  the  early  stages  of  the  operation. 
There  is  one  influence  of  immense  advantage  to 
be  used  in  the  management  of  these  patients, — 
viz.,  encouragement  and  commendation.  To  say 
an  encouraging  word  and  to  compHment  the  pa- 
tient on  the  manner  in  which  the  operation  is 
being  endured  is  frequently  a  wonderful  stimu- 
lus. But  occasionally  a  case  presents  in  which 
the  patient  is  more  foolish  than  nervous  and 
where  a  certain  amount  of  firmness  and  decision 
is  needed.  If  an  operator  continues  to  allow  a 
patient  of  this  type  to  impose  on  him,  he  not 
only  wastes  his  time,  but  even  loses  the  respect 
of  the  patient.  Every  practitioner  should  make 
a  careful  study  of  this  type  of  patient  so  that  he 
may  quickly  distinguish  between  an  individual 
who  is  really  nervous,  and  who  accordingly  re- 
quires and  deserves  the  utmost  consideration, 
and  one  who  is  simply  irresponsible  and  whimsi- 
cal. This  latter  class  can  usually  be  detected  by 
a  little  artifice  on  the  part  of  the  operator.  If 
there  is  a  suspicion  in  his  mind  that  the  patient 
is  feigning  distress  in  an  operation  where  there 
is  no  occasion  for  it,  by  flinching  and  otherwise 
acting  badly,  he  can  test  the  matter  very  readily 


MANAGING   PATIENTS 


73 


by  merely  placing  an  excavator  or  other  instru- 
ment with  some  pressure  against  a  sound  part  of 
the  tooth  where  he  knows  there  is  no  possible 
chance  of  causing  any  pain.  It  will  frequently 
be  found  with  this  type  of  patient  that  there  will 
be  the  same  flinching  and  the  same  protestations 
of  pain  as  if  a  sensitive  part  of  the  cavity  had 
actually  been  touched.  It  has  merely  become  a 
fixed  habit  with  the  patient  to  protest,  and  such 
persons  seem  never  to  feel  quite  satisfied  unless 
they  are  discommoding  the  operator  in  every 
conceivable  way.  This  sort  of  trifling  with  an 
operator's  time  and  patience  should  not  be  toler- 
ated in  the  slightest  degree,  and  when  the  im- 
position is  once  discovered  the  patient  should  be 
given  to  understand  most  emphatically  that  the 
operator  has  some  rights  in  the  case  and  that 
he  proposes  to  enforce  them.  It  may  at  times 
even  be  necessary  to  be  somewhat  severe  with 
such  patients;  but  the  dentist  should  never  be 
ungentlemanly  in  any  instance,  and  wdierever 
severity  is  used  it  should  invariably  be  tempered 
by  a  subsequent  kindliness  of  manner  which 
proves  to  the  patient  before  the  sitting  is  over 
that  the  dentist  is  not  pettish  or  vindicative  and 


74 


SUCCESS   IN   PRACTICE 


that  he  does  not  give  way  to  severity  through 
any  display  of  temper.  Above  all  things  the 
patient  should  be  dismissed  from  the  office  carry- 
ing away  an  impression  that  the  dentist  is  master 
of  the  situation,  but  that  he  dispenses  his  mastery 
with  the  utmost  kindness.  A  dentist  owes  it  to 
himself,  to  his  patients,  and  particularly  to  his 
profession  that  he  maintains  the  reputation  of 
being  at  all  times  a  high-minded  gentleman,  and 
in  no  instance  of  his  professional  relationship  is 
this  of  greater  moment  than  in  his  dealing  with 
the  class  of  patients  under  consideration. 

It  is  often  possible  by  the  exhibition  of  a  little 
tact  and  judgment  to  so  control  some  of  these 
irresponsible  individuals  that  a  permanent  im- 
pression is  made  upon  them  to  the  betterment  of 
their  disposition,  and  a  dentist's  influence  for 
good  may  thereby  be  widened  far  beyond  the 
mere  service  he  performs  upon  the  teeth.  A 
man  in  any  walk  of  life  should  have  the  broadest 
possible  conception  of  his  duty  to  his  fellow-man, 
and  in  the  practice  of  a  profession  this  duty  is 
particularly  obligatory ;  so  that  a  dentist  should 
never  be  content  with  the  mere  performance  of 
his  technical  operations  without  a  wider  interest 


MANAGING    PATIENTS 


75 


in  his  patient's  general  welfare.  This  does  not 
imply  that  a  dentist  should  ever  go  out  of  his 
way  to  pry  into  matters  that  are  none  of  his 
affair.  A  gossipy,  inquisitive  dentist  is  an  abomi- 
nation in  the  sight  of  intelligent  people,  and, 
aside  from  its  impertinence,  such  a  course  is  espe- 
cially prejudicial  to  his  success.  But  he  can  take 
an  active  interest  in  his  patient  and  can  often 
find  opportunities  for  a  genuine  service  in  char- 
acter-building— particularly  with  children  and 
nervous,  irresponsible  individuals — without  in 
the  slightest  degree  intruding  beyond  the  limits 
of  propriety  or  in  any  way  compromising  him- 
self. 

The  Management  of  Patients  in  General. — As 
has  already  been  intimated,  no  dentist  can  expect 
to  be  successful  unless  he  first  learns  how  to 
manage  the  different  types  of  people  who  come 
to  him.  A  dentist  should  be  able  to  read  char- 
acter in  the  face  of  every  individual  and  to  know 
how  to  approach  each  different  class  the  moment 
they  appear.  Not  that  he  should  constantly  sink 
his  own  individuality  into  that  of  others,  but  that 
he  may  so  control  the  individualities  of  those  who 
come  under  his  ministrations  that  he  can  make 


je  SUCCESS   IN   PRACTICE 

his  practice  run  along  smoothly  and  without  the 
friction  which  often  mars  the  career  of  the  most 
promising  practitioner.  Enough  has  already 
been  said  along  this  line,  but  its  importance  can- 
not be  too  strongly  urged  nor  too  often  repeated. 


VI 

RECORDS   AND    BOOK-KEEPING 

In  approaching  this  part  of  the  subject  the 
author  reaHzes  that  he  is  assuming  a  herculean 
task  in  attempting  to  convince  the  dental  profes- 
sion of  the  necessity  for  keeping  acurate  records 
and  for  estabHshing  and  maintaining  a  business- 
Hke  method  of  book-keeping.  It  has  long  be- 
come proverbial  that  the  average  dentist  is 
notoriously  careless  when  it  comes  to  matters  of 
record,  and  so  far  as  his  accounts  are  concerned 
it  would  tax  more  than  the  genius  of  an  expert 
book-keeper  to  unravel  them  and  make  them  in- 
telligible to  an  ordinary  business-man. 

The  necessity  for  keeping  records  relates  not 
only  to  the  business  aspect  of  the  case  but  to  the 
professional  as  well.  No  man  can  gain  the 
greatest  possible  benefit  from  his  experience  in 
practice  without  having  records  of  his  work  for 
ready  reference  as  a  basis  to  guide  him  in  future. 
It  is  only  by  this  means  that  he  can  form  an 

77 


78  SUCCESS  IN   PRACTICE 

adequate  idea  as  to  the  relative  value  in  his  hands 
of  the  different  methods  of  practice.  He  may 
read  in  the  journals  and  text-books  of  the  char- 
acteristics of  the  various  materials  used  for  filling 
teeth,  but  not  till  he  has  demonstrated  in  his 
own  practice  the  relative  permanence  of  each 
material  is  he  in  a  position  to  properly  judge  as 
to  which  material  is  the  one  for  him  to  use  in  a 
given  case.  He  may  see  in  our  literature  various 
methods  of  practice  advocated,  and  he  may  form 
an  opinion  as  to  which  method  he  should  follow, 
but  until  he  has  made  a  practical  test  and  ob- 
served the  results  he  is  not  qualified  to  properly 
discriminate  in  favor  of  one  method  as  against 
another. 

And  the  only  way  to  judge  of  the  value  of 
materials  or  methods  is  through  the  medium  of 
records  carefully  preserved.  If  an  operator  has 
a  record  of  each  operation,  with  the  date,  the 
kind  of  material  used,  and  other  particulars,  he 
can  at  once  refer  to  the  history  of  a  given  piece 
of  work  when  he  sees  it  and  be  able  to  form 
an  opinion  as  to  the  virtue  of  that  method  of 
practice. 

The  clinical  value  of  a  well-kept  record  be- 


RECORDS   AND   BOOK-KEEPING 


79 


comes  inestimable  as  the  years  go  on,  and  it  may 
eventually  be  turned  to  the  advantage  of  the 
profession  at  large  as  well  as  to  the  individual 
himself  by  a  publication  of  the  data  furnished 
by  it  upon  any  given  subject.  It  is  therefore  a 
duty  which  each  man  owes  the  profession  to  so 
record  his  work  that  the  sum  total  of  the  knowl- 
edge gained  thereby  shall  be  added  to  the  infor- 
mation already  extant  upon  the  subject,  to  the 
end  that  the  greatest  progress  possible  be  made 
by  the  profession  as  a  body. 

But  even  if  the  professional  phase  of  the  ques- 
tion does  not  appeal  to  a  man,  there  is  still  an 
argument  which  should  move  every  practitioner 
not  to  think  lightly  upon  so  important  a  precau- 
tion from  a  business  point  of  view.  This  relates 
to  his  protection  from  imposition  on  the  part  of 
patients  concerning  the  permanence  or  otherwise 
of  the  work  which  he  has  done  for  them.  It  is 
manifestly  out  of  the  question  for  a  dentist  to 
remember  the  facts  about  each  filling  he  inserts, 
the  kind  of  material,  the  date  upon  which  it  was 
inserted,  or  other  particulars  of  the  operation ; 
and  if  he  makes  a  practice  of  merely  charging 
for  an  operation  without  keeping  a  special  record 


8o  SUCCESS   IN   PRACTICE 

of  it  he  is  at  the  mercy  of  the  patient  so  far  as 
concerns  its  length  of  service.  Patients  are 
much  inclined  to  misrepresent  an  operator  in  this 
particular,  sometimes  innocently  and  sometimes 
wilfully. 

If  a  filling,  for  instance,  is  lost  from  a  cavity 
anywhere  in  the  mouth  it  is  quite  the  habit  for 
persons  to  jump  to  the  conclusion  that  it  was  in- 
serted by  the  operator  who  last  worked  for 
them,  and  he  frequently  gets  the  reputation  of 
having  done  a  faulty  piece  of  work  unless  he  can 
prove  otherwise.  It  is  often  the  case  that  a 
patient  suddenly  finds  a  cavity  in  a  region  of 
the  mouth  where  within  a  year  there  has  been  a 
filling  inserted,  and  the  natural  inference  is  that 
the  filling  has  tumbled  out.  Cases  of  this  kind 
often  occur  where  the  enamel  suddenly  breaks 
in  over  a  carious  place  and  makes  manifest  a 
large  cavity  which  previously  had  been  hidden 
from  the  patient,  and  in  the  assertion  that  a  fill- 
ing has  been  lost  a  patient  may  be  perfectly 
innocent.  Then  again  it  is  an  unfortunate  fact 
that  there  are  some  individuals  who  do  not  hesi- 
tate to  charge  a  dentist  with  the  loss  of  a  filling 
when  they  know  he  is  blameless,  as  a  subterfuge 


RECORDS   AND    BOOK-KEEPING  $1 

to  gain  favoritism  in  its  reinsertion.  There  are 
numberless  abuses  of  this  character  which  assail 
a  busy  practitioner,  and  his  only  safeguard  is  a 
system  of  well-kept  records.  When  it  becomes 
prominently  known  that  he  records  every  opera- 
tion, patients  will  be  more  careful  about  at- 
tributing failures  to  him  until  they  are  certain 
of  their  ground;  and  in  the  event  of  an  honest 
difference  of  opinion  in  regard  to  the  character 
of  an  operation  or  the  length  of  service  it  has 
given,  the  matter  can  readily  be  cleared  up  to 
the  satisfaction  of  all  concerned  by  a  reference  to 
the  records.  Not  only  this,  but  the  fact  that  a 
dentist  keeps  records  of  his  operations  at  once 
establishes  confidence  on  the  part  of  patients. 
They  are  impressed  with  the  fact  that  he  is  will- 
ing to  stand  by  his  work  and  abide  the  conse- 
quences, and  they  come  to  him  with  all  the 
greater  assurance  that  he  is  a  responsible  party. 
In  fact,  the  most  desirable  class  of  patients  are 
so  fast  becoming  educated  to  the  idea  of  having 
records  kept  that  they  are  naturally  suspicious 
of  the  operator  who  fails  in  this  important  par- 
ticular; and  if  a  dentist  were  unable  to  show 
such  a  patient  a  diagram  of  the  work  done  he 


82  SUCCESS    L\    PRACTICE 

■would  at  once  lose  caste  so  far  as  that  patient 
was  concerned. 

It  is  an  immense  satisfaction  after  many  years 
of  practice  in  one  locality  for  the  operator  to  be 
able  to  refer  to  the  records  of  operations  per- 
formed for  his  long-standing  patients,  and  note 
the  tenure  of  service  performed  by  some  of  his 
painstaking  operations.  It  is  almost  invariably 
the  case  that  patients  err  somewhat  in  their  esti- 
mate as  to  the  length  of  time  a  given  operation 
has  stood.  Xo  matter  how  vividly  they  may 
remember  the  circumstances  of  an  operation,  they 
are  inclined  as  the  years  go  by  to  place  the 
time  of  its  performance  at  a  period  more  recent 
than  is  actually  the  case,  and  this  occurs  with 
the  most  conscientiotis  patients.  It  is  only  in 
line  with  the  tmiversal  fact  of  the  rapid  flight  of 
time  and  is  no  reflection  on  their  veracity.  But 
it  is  sometimes  a  great  satisfaction  for  the  den- 
tist to  be  able  to  turn  to  his  records  and  establish 
the  precise  date  for  the  patient.  They  are  thereby 
frequently  impressed  with  the  value  of  dental 
senflce  in  a  way  that  nothing  else  could  accom- 
plish, and  are  at  once  placed  in  a  more  apprecia- 
tive mood  towards  future  ettorts  on  the  pan  of 


RECORDS   AND   BOOK-KEEPING  83 

the  practitioner.  They  are  also  more  willing  to 
adequately  remunerate  the  dentist  for  his  work. 

A  case  in  point  may  be  related  as  typical  of 
many  similar  ones  which  arise  in  the  experience 
of  every  practitioner  of  long  standing.  A  patient 
one  day  pointed  to  a  gold  crown  on  a  lower 
molar  and  remarked  that  it  was  the  best  tooth 
he  had.  The  dentist  asked  him  how  long  it  had 
been  in  use.  He  thought  a  moment,  and  said : 
"  It  must  have  been  put  on  nine  or  ten  years 
ago." 

The  operator  consulted  his  records,  and  found 
that  the  crown  had  been  placed  there  fifteen  years 
before;  and  when  the  patient  heard  this  he  ex- 
pressed surprise,  and  asked :  "  How  much  did 
you  charge  me  for  that  crown?" 

"  Twenty  dollars." 

"  Well,  it  has  paid  for  itself  many  times  over. 
\\'hat  a  pity  my  teeth  were  not  properly  attended 
to  when  I  was  younger." 

A  father  with  sentiments  like  these  is  not  likely 
to  allow  his  children's  teeth  to  go  neglected,  and 
the  aggregate  of  impressions  made  upon  the 
people  in  this  way  will  go  farther  than  anything 
else  towards  developing  a  proper  regard  for  the 


84  SUCCESS   IN   PRACTICE 

value  of  dental  service  and  a  desire  to  have  it 
attended  to  early  in  life.  Without  a  record  and 
a  diagram  properly  marked  it  would  have  been 
difficult  to  make  this  gentleman  believe  that  his 
crown  had  done  service  so  many  years,  but  with 
the  record  there  was  no  longer  any  doubt. 

Another  case :  A  gentleman  had  a  gold  filling 
inserted  in  the  mesial  surface  of  an  upper  lateral 
incisor  many  years  before.  Subsequently  and 
within  recent  years  he  had  the  proximating  cen- 
tral filled  in  its  distal  surface  by  another  opera- 
tor. One  day  the  filling  in  the  lateral,  after  years 
of  faithful  service,  fell  out,  and  the  patient  ap- 
plied to  the  second  operator  with  the  information 
that  his  filling  had  failed.  An  examination 
showed  the  filling  in  the  central  to  be  in  good 
condition,  and  the  patient  was  so  informed. 

"  Yes,"  said  he,  "  but  this  is  the  tooth  you 
filled,"  pointing  to  the  lateral. 

The  operator  shook  his  head  in  denial. 

"  Why,"  said  the  patient,  bristling  up  some- 
what, "  you  put  that  filling  in  the  last  time  I  was 
in  your  office.  I  remember  distinctly  all  of  the 
circumstances  connected  with  it.  Don't  you  re- 
call having  said  that  the  tooth  was  rather  frail 


RECORDS   AND   BOOK-KEEPING  85 

at  one  point  and  that  you  were  not  perfectly  cer- 
tain how  permanent  the  filling  would  be?" 

"  If  I  said  that,  it  was  said  of  another  tooth," 
remarked  the  operator. 

The  patient  was  somewhat  impetuous,  and  was 
on  the  verge  of  a  rather  pointed  protest  when 
the  operator  turned  to  his  records  and  proved 
thereby  that  he  had  never  touched  the  lateral,  but 
that  the  filling  he  had  inserted  was  in  the  cen- 
tral. 

"  Well,  I'll  be  blowed !"  exclaimed  the  patient. 
"  I  would  have  sworn  that  you  filled  that  tooth ; 
but  of  course  I  can't  go  behind  your  records." 
And  then  he  sat  a  moment  reflectively,  and  sud- 
denly broke  out :  "  Say,  if  it  wasn't  for  keeping 
records  the  way  you  do,  you  would  be  hum- 
bugged like  the  very ,  wouldn't  you?" 

To  all  of  which  the  operator  fervently  agreed. 

Another  important  advantage  of  keeping 
records  relates  to  the  rendering  of  accounts,  a 
matter  which  will  receive  more  detailed  con- 
sideration further  on.  In  fact,  no  dentist  can 
hope  to  keep  his  affairs  in  systematic  or  satis- 
factory order  who  fails  to  make  and  preserve 
accurate  records  of  all  his  work. 


86  SUCCESS  IN   PRACTICE 

Methods  of  keeping  Records  and  Accounts. — 
There  are  two  principal  methods  of  keeping  ac- 
counts and  two  of  making  records.  Accounts 
may  be  kept  by  means  of  the  index-card  system 
or  by  books  in  the  usual  way.  Some  operators 
prefer  the  card  system  as  being  best  adapted  to 
their  use,  while  others  favor  books,  and  each 
operator  should  examine  both  systems  and  select 
that  which  most  appeals  to  him.  There  is  this 
to  be  said  in  favor  of  books,  that  in  many  years 
of  practice  the  bulk  of  cards  which  accumulate 
where  records  are  preserved  as  they  should  be 
is  as  much  greater  than  books  as  the  cards  are 
thicker  than  paper,  and  an  operator  can  therefore 
keep  preserved  between  the  covers  of  the  book 
a  larger  number  of  records  and  accounts  in  given 
bulk  than  he  could  of  cards  stored  away  in  boxes. 
The  card  system  may  in  some  cases  appeal  to 
beginners  on  account  of  a  few  favorable  features, 
but  with  men  in  practice  who  have  already  a 
large  number  of  records  in  book  form  it  can 
hardly  be  expected  that  they  will  change  their 
system  for  something  so  radically  different. 

As  to  the  manner  of  making  records  of  opera- 
tions there  are,  as  has  been  said,  two  plans, — 


RECORDS   AND   BOOK-KEEPING  8/ 

one  by  means  of  a  code  and  the  other  by  a  dia- 
gram. The  code  system  is  descriptive,  while  the 
diagram  is  illustrative.  To  use  the  code  method 
the  operator  must  employ  to  a  large  degree  the 
first  letter  of  a  word  in  lieu  of  the  word  itself. 
For  instance,  if  he  has  inserted  a  filling  in  the 
disto-occlusal  surface  of  a  bicuspid,  instead  of 
writing  "  disto-occlusal,"  he  merely  writes 
"  d-o,"  and  this  kind  of  abreviation  is  carried  on 
throughout  the  system.  By  this  method  no  dia- 
gram is  used ;  and  while  with  some  who  have 
studied  the  matter  closely  and  have  used  it  for 
some  time  in  practice  there  may  be  a  fair  degree 
of  accuracy  about  it,  yet  to  the  mind  of  the 
author  it  cannot  compare  in  several  important 
particulars  with  the  diagram  method.  In  the 
first  place,  to  trace  a  certain  filling  from  the 
mouth  to  the  date  on  the  ledger  or  record  book 
one  might  at  times  be  obliged  to  go  through  the 
entire  record  before  coming  across  this  particular 
filling,  while  with  a  diagram  a  mere  glance  at  the 
tooth  in  the  record  book  with  its  accompanying 
number  will  tell  the  whole  story  at  once.  Then 
again  a  code  system  is  never  quite  so  impressive 
to  patients,  and,  short  of  a  great  deal  of  unneces- 


88  SUCCESS  IN   PRACTICE 

sary  explanation,  cannot  be  made  sufficiently  in- 
telligible to  appeal  to  them ;  but  a  diagram,  wjth 
the  teeth  clearly  outlined  and  a  filling  in  a 
given  position  on  any  tooth  plainly  marked,  in- 
stantly conveys  its  own  description  and  can  be 
readily  understood.  For  these  reasons,  and  for 
others  which  will  become  apparent  later  on,  the 
diagram  method  should  be  adopted  for  general 
use. 

Examination  of  the  Teeth. — When  a  patient 
applies  for  dental  service  and  requests  an  exami- 
nation of  the  teeth,  the  examination-blanks  put 
up  in  pads  by  the  dealers  with  a  diagram  of  the 
teeth  upon  them  should  be  used  for  recording 
cavities  in  the  presence  of  the  patient.  It  is 
seldom  that  patients  have  any  idea  of  the  number 
of  cavities  they  have  in  their  teeth,  and  it  is 
always  best  to  impress  them  with  the  precise  con- 
dition of  affairs  at  the  outset,  so  that  there  can 
be  no  subsequent  misunderstanding  about  the 
amount  of  work  to  be  done.  The  surest  way  to 
do  this  is  to  place  the  examination-pad  upon  the 
operating-table  in  front  of  the  patient,  and,  as 
the  examination  goes  on,  record  each  cavity  with 
a  pencil  on  the  exact  region  of  the  tooth  where 


RECORDS   AND   BOOK-KEEPING  89 

the  cavity  occurs,  and  draw  a  line  out  from  the 
cavity  towards  the  margin  of  the  examination- 
shp.  These  Hues  radiating  out  from  the  cavities 
serve  a  useful  purpose  in  several  ways.  They 
can  be  numberetl  to  indicate  the  cavity  instead 
of  attempting  to  place  the  number  near  the 
cavity  and  thus  blur  the  diagram  of  the  tooth, 
and  besides  they  prove  an  eloquent  reminder  to 
the  patient  as  to  the  number  of  cavities  present 
in  the  mouth.  If,  when  the  examination  is  com- 
pleted and  the  cavities  recorded,  the  patient  does 
not  seem  to  be  sufficiently  impressed  with  the 
extent  of  the  work  to  be  done,  and  it  is  thought 
advisable  to  call  attention  to  it,  a  very  neat  way 
of  doing  so  is  to  merely  count  the  cavities  on  the 
examination-slip  and  to  check  them  ofif  in  the 
presence  of  the  patient.  This  will  instantly  im- 
press the  matter  upon  the  patient's  notice,  so  that 
there  can  be  no  possible  chance  of  misconception. 
When  the  examination  is  completed  and  an 
appointment  made,  the  slip  should  be  placed  on 
a  hook  provided  for  this  purpose  convenient  to 
the  operating-case,  and  every  morning  before 
office  hours  the  appointment-book  should  be  ex- 
amined and  the  slips  for  the  patients  who  have 


90  SUCCESS  IN  PRACTICE 

appointments  for  that  day  should  be  placed  in 
regular  rotation  on  top  of  all  other  slips,  so  as 
to  be  convenient.  When  a  patient  takes  the 
chair,  a  mere  glance  at  the  slip  shows  what  is 
to  be  done,  and  this  does  away  with  the  neces- 
sity of  examining  the  teeth  each  time  the  patient 
comes.  When  a  tooth  is  filled,  an  indication  of 
this  fact  with  the  kind  of  material  used  is  made 
on  the  examination-slip,  as  will  be  illustrated 
later,  and  the  slip  laid  aside  till  the  day's  work 
is  done.  At  the  end  of  the  day  the  operator  can 
take  the  slips  for  that  day  and  transfer  with  ink 
the  records  to  the  diagrams  in  the  ledger,  and 
make  the  charges.  As  he  does  this  he  can  cancel 
the  fillings  thus  recorded  on  the  examination- 
slips,  so  that  a  glance  will  show  which  cavities 
have  been  filled  and  which  not.  The  slips  are 
then  hung  on  the  hook  again  ready  for  the  next 
appearance  of  the  patient.  If  an  operator  em- 
ploys an  assistant,  as  all  operators  should,  this 
clerical  work  can  be  relegated  to  the  assistant, 
and  all  the  record-making  that  the  operator  need 
to  do  is  to  mark  the  cavities  in  pencil  on  the 
examination-slip  as  he  looks  over  the  mouth  for 
the  first  time. 


RECORDS    AND    BOOK-KEEPING 


91 


To  illustrate  the  working'  of  the  system  the 
following  examination-slip  may  be  taken  as  typi- 
cal : 
igo  Pa 

]\^r.  H.    Y.  Jones 
A^        8 J  Blank  Street 
T»a    First  National  Bank 


92  SUCCESS   IN   PRACTICE 

This  slip  in  its  present  condition  shows  that 
the  left  lower  second  molar  has  been  filled  Vv^ith 
amalgam  and  that  the  roots  have  also  been  filled 
as  indicated  by  the  small  mark  to  the  lingual. 
The  cross  over  the  filling  cancels  the  record  and 
shows  that  it  has  been  transferred  to  the  ledger. 
The  upper  right  second  bicuspid  has  been  filled 
with  gold  and  the  record  transferred  to  the 
ledger.  The  distal  surface  of  the  upper  left  cus- 
pid and  the  occlusal  surface  of  the  lower  left  first 
permanent  molar  have  been  filled  with  gold  but 
have  not  yet  been  recorded  in  the  ledger.  All 
the  other  cavities  are  still  unfilled.  The  cancel- 
mark  being  made  with  ink  over  the  pencil  cavity- 
mark,  shows  very  plainly,  and  the  merest  glance 
at  the  slip  indicates  instantly  the  progress  of  the 
work  in  that  mouth. 

The  Ledger. — This  patient's  page  in  the 
ledger  at  this  stage  would  appear  as  shown  in 
the  accompanying  diagram.  ( Fernandez  ledger. ) 

This  would  mean  that  on  October  3  the  teeth 
had  been  cleaned  and  a  treatment  made,  con- 
suming three-quarters  of  an  hour,  and  for  which 
a  charge  of  seven  dollars  was  made.  It  is  always 
well,  whether  the  dentist  charges  by  the  opera- 


nm  r.  H.   Y.  Jonrs 

83  Blank  Street 


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RECORDS  AND   BOOK-KEEPING  93 

tion  or  by  the  hour,  to  indicate  the  length  of  time 
spent  in  such  work  as  cleaning  or  treating,  in 
case   of   any   question   arising   regarding    fees. 
People  in  general  have  not  yet  been  sufficiently 
educated  to  a  just  appreciation  of  the  effort  ni- 
volved  in  cleaning  and  treating  teeth,  and  they 
are  inclined  to  look  upon  it  as  a  trifling  service. 
A  filling  is  something  'tangible  to  them,  and  they 
are  willing  to  pay  for  it,  but  an  adequate  charge 
for  cleaning  or  treating  is  sometimes  resented 
unless  the  dentist  can  show  them  the  actual  time 
spent  in  such  work.    On  October  6  a  gold  filling 
was  inserted  and  a  treatment  made, — fee  twelve 
dollars.    The  number  in  the  third  column  of  the 
ledger  corresponding  with  the  number  on  the 
diagram  shows  the  precise  filling  which  was  m- 
serted  on  that  date.    On  this  same  day  the  patient 
paid  ten  dollars  on  account,  which  is  duly  entered 
in  the  credit  column.     On  October  13  the  roots 
of  the  lower  molar  were  filled  and  amalgam  in- 
serted in  the  cavity, — fee  seven  dollars. 

Thus  the  record  and  account  may  be  carried 
on  down  till  the  work  is  finished,  and  when  more 
work  is  done  for  the  patient  at  a  subsequent  date 
it  is  entered  on  this  same  page  and  the  record 


94 


SUCCESS  IN  PRACTICE 


of  the  mouth  kept  complete  in  one  place,  to  be 
referred  to  at  a  moment's  notice.  There  is 
always  room  at  the  margin  of  the  diagram  or  at 
the  foot  of  the  account  column  to  record  any- 
thing special  about  a  given  tooth,  so  that  the 
entire  history  of  the  mouth  may  be  kept  in  the 
most  compact  and  convenient  manner.  By  the 
use  of  abbreviations  to  indicate  operations  and 
fillings  as  here  illustrated  it  is  possible  to  con- 
dense a  vast  number  of  records  and  a  very  exten- 
sive series  of  accounts  in  one  book,  thus  giving 
a  ready  reference  under  one  cover  for  a  great 
many  patients. 

Mailing-Sheets. — To  facilitate  the  monthly 
rendering  of  accounts  it  is  necessary  to  have  some 
plan  whereby  the  operator  or  his  book-keeper  is 
not  obliged  to  go  through  the  entire  ledger  or 
series  of  ledgers  each  month  in  search  of  unpaid 
accounts.  This  is  readily  managed  by  having 
ruled    mailing-sheets    printed,    as    shown    on 

page  95- 

These  sheets  should  be  about  eight  by  eleven 
inches  in  size ;  and  when  a  patient's  work  is  com- 
pleted and  the  last  entry  made  in  the  ledger, 
the  book-keeper  should  place  the  name  on  this 


RECORDS  AND   BOOK-KEEPING 


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96  SUCCESS   IN   PRACTICE 

sheet,  with  the  address,  page  of  the  ledger  ac- 
count, date  of  the  work,  etc.,  as  indicated,  and 
from  this  the  accounts  may  be  made  out  each 
month  and  mailed.  By  this  means  not  only  is 
the  mailing  of  accounts  rendered  very  easy,  but 
the  operator  has  at  all  times  a  list  of  outstanding 
bills  gathered  together  in  the  most  compact  form. 
These  sheets  may  be  conveniently  slipped  into 
the  front  or  back  of  the  ledger  for  the  most  ready 
reference,  and  it  is  usually  well  every  six  months 
to  go  through  the  ledger  to  see  that  all  outstand- 
ing accounts  are  recorded  on  the  sheets.  When 
an  account  is  paid,  a  line  should  be  drawn 
through  it  to  cancel  it,  in  addition  to  crediting  it 
in  the  ledger. 

The  Day-Book. — In  order  to  keep  informed 
on  the  amount  of  charges  and  cash  for  each  day 
it  is  necessary  to  have  a  book  ruled  somewhat  in 
the  manner  shown  on  page  97. 

This  would  indicate  that  on  November  3, 
1902,  Mr.  G.  H.  Brownmier  had  ten  dollars 
worth  of  work  done ;  that  Mrs.  E.  X.  Zane  had 
eight  dollars  charged,  and  paid  five  dollars  on 
account ;  and  that  Mr.  O.  V.  Blank  made  a  pay- 
ment of  twelve  dollars  on  a  previous  account. 


RECORDS  AND   BOOK-KEEPING 

November,  igoz 


97 


CHARGES      CASH 


G.  H.  Browtmiier 
3lrs.  E.  X.  Zane 
O.   V.  Blank 


$io 


$5 

12 


The  columns  of  charges  and  cash  may  be  footed 
up  and  carried  forward  from  page  to  page  till 
the  end  of  the  month,  when  the  sum  total  of  each 
may  be  reckoned,  and  the  dentist  knows  at  once 
how  much  work  he  has  done  and  the  amount  of 
cash  taken  in  during  the  month. 

At  the  end  of  this  day-book  a  page  may  be 
ruled  off  in  such  a  way  as  to  record  the  monthly 
charges  and  receipts,  from  which  by  the  mere 

7 


98 


SUCCESS  IN   PRACTICE 


adding  up  of  a  column  may  be  estimated  the 
yearly  statement : 


1902 

CHARGES 

CASH 

1903 

CHARGES 

CASH 

Jan. 

Feb 

March . . . 

April 

May 

June 

July 

August . . 

Sept 

Oct 

Nov 

Dec 

$1,184 
1,033 

1,345 
1,405 

983 
1,534 
1,213 

750 
1,079 
1,428 
1,346 
1,106 

11,296 

948 

1,298 

1,501 

1,047 

1,318 

1,108 

914 

836 

1,309 
1,401 

983 

Total.. 

114,406 

|i3,959 

By  this  method  a  glance  will  show  the  amount 
of  work  done  and  cash  collected  in  a  given  month 
or  a  given  year,  and  the  plan  is  very  simple  and 
not  at  all  cumbersome  in  its  practical  application. 

The  system  of  records  and  book-keeping  herein 
outlined  is  not  submitted  as  being  ideal  or  suited 
to  the  needs  of  every  practitioner,  but  that  it  is 
a  very  effective  system  has  been  amply  proved 


RECORDS  AND   BOOK-KEEPING 


99 


by  many  years'  test,  and  the  more  the  records 
accumulate  and  the  accounts  extend  the  more 
effective  does  it  seem  to  become.  Through  this 
agency  the  operator  may  almost  instantly  refer 
to  the  diagram  record  of  any  mouth,  he  may 
know  at  once  how  a  certain  account  stands,  he 
can  have  his  bills  mailed  each  month  from  a 
convenient  list,  and  he  can  determine  at  a  mo- 
ment's notice  the  exact  amount  of  work  and  the 
cash  receipts  of  any  given  day,  month,  or  year. 

Whether  this  particular  method  is  used  or 
some  other  plan  more  suited  to  the  individual 
operator,  the  plea  is  once  again  very  strongly 
urged  to  establish  a  system  of  record-making  and 
book-keeping  whereby  the  business  interests  and 
professional  status  of  the  profession  shall  be 
maintained  in  the  highest  possible  degree  of 
excellence  and  precision. 


VII 

APPOINTMENTS  AND   SITTINGS 

In  such  work  as  dentistry  it  is  usually  neces- 
sary that  it  be  done  for  the  most  part  on  appoint- 
ment. Of  course  exigencies  arise  in  every  prac- 
tice which  demand  immediate  attention,  but  for 
extended  operations  the  only  satisfactory  way  is 
to  arrange  for  them  in  advance.  In  view  of  the 
fact  that  the  dentist's  time  is  his  capital,  he 
should  early  seek  to  establish  among  his  patients 
a  just  appreciation  of  the  necessity  for  punc- 
tuality, and  in  order  to  do  this  he  must  always 
aim  to  be  punctual  himself.  There  must  of 
course  be  a  little  latitude  for  emergencies  on  the 
part  of  both  operator  and  patient,  and  this  should 
be  taken  good-humoredly,  but  the  general  rule 
should  obtain  that  when  an  appointment  is  made 
it  shall  be  kept  promptly  on  both  sides. 

Broken  Appointments. — There  should  be  an 
understanding  with  the  patients  that  when  an 
appointment  is  not  kept  there  shall  be  a  just 


APPOINTMENTS   AND   SITTINGS  loi 

remuneration  for  loss  of  time  unless  the  dentist 
receives  sufficient  notice  to  fill  the  time  with 
another  patient.  To  justify  himself  in  making 
such  a  charge  he  should  have  a  notice  on  his 
appointment-cards  to  the  effect  that  the  time 
appointed  is  reseryed  for  the  patient  and  that  a 
failure  to  keep  the  appointment  will  necessitate 
a  charge  for  loss  of  time  unless  a  reasonable 
notice  is  given.  Every  patient  who  makes  an 
appointment  should  receive  a  card  with  the  day 
and  hour  plainly  marked  on  it,  to  avoid  mistakes 
through  misunderstanding  or  forgetfulness.  If 
an  appointment  is  made  by  telephone,  it  is  usually 
best  to  mail  an  appointment-card  or  request  the 
patient  to  make  a  note  of  it  at  the  time  the 
appointment  is  made. 

Examination  Notices. — Connected  with  the 
appointment  system  there  is  a  certain  feature  in 
vogue  in  the  better  offices  which  should  be  more 
generally  introduced  than  it  is.  This  relates  to 
a  system  of  notification  whereby  patients  are 
reminded  at  stated  intervals  by  the  dentist  that 
their  teeth  should  be  examined  and  an  appoint- 
ment arranged  for  that  purpose.  With  patients 
who  are  extensively  occupied  with  other  affairs 


I02  SUCCESS   IN   PRACTICE 

— as  most  patients  are — the  time  is  too  often 
allowed  to  slip  by  till  the  teeth  are  suffering 
through  neglect,  sometimes  to  the  extent  of  irrep- 
arable damage.  If  there  is  a  mutual  under- 
standing between  patient  and  dentist,  the  matter 
may  be  so  arranged  that  a  memorandum  is  made 
in  the  appointment-book,  and  the  patient  notified 
at  the  proper  time  to  appear  for  examination. 
Most  patients  if  intelligent  are  very  appreciative 
of  this  service,  and  the  arrangement  is  exceed- 
ingly satisfactory  to  all  parties  concerned.  It 
relieves  the  patient  of  the  responsibility  of  re- 
membering that  his  teeth  may  need  attention  and 
assures  him  that  they  will  not  be  neglected,  while 
it  enables  the  dentist  to  keep  better  control  of  the 
teeth  and  to  avoid  annoying  complications 
through  deferring  operations  too  long. 

A  propitious  time  to  broach  this  plan  to  the 
patient  is  at  the  conclusion  of  a  series  of  sittings 
which  have  been  made  more  taxing  and  pro- 
longed on  account  of  previous  neglect,  when  the 
patient  is  usually  in  a  mood  to  gladly  welcome 
such  an  arrangement.  Of  course  in  no  instance 
should  such  a  notice  be  sent  to  a  patient  without 
a  previous  understanding  in  the  matter,  lest  there 


APPOINTMENTS   AND   SITTINGS  103 

arise  a  suspicion  in  the  mind  of  the  patient  that 
the  dentist  is  soHciting  patronage.  To  prove  to 
patients  that  it  is  the  regular  custom  of  the  prac- 
titioner to  send  these  notices,  it  is  well  to  have 
notification-cards  printed  ready  for  mailing  at 
the  appointed  time.  These  cards  may  read  some- 
thing like  this : 

"  In  accordance  with  your  request  of  (naming 
the  date  of  last  sitting)  I  beg  leave  to  remind 
you  that  your  teeth  should  be  examined  at  this 
time." 

Or,  if  the  patient  prefers,  the  notification  may 
be  made  by  telephone. 

This  plan  carried  out  extensively  in  one's  prac- 
tice insures  good  attention  to  the  teeth  and 
enables  the  operator  to  systematize  his  work  and 
utilize  his  time  to  the  best  advantage. 

Length  of  Sittings. — There  is  a  great  variation 
among  practitioners  in  regard  to  the  number 
of  appointments  they  make  in  a  day,  and  every 
man  must  arrange  his  sittings  according  to  the 
plan  which  appeals  most  to  him ;  but  in  a  general 
way  operators  should  avoid  giving  long  sittings 
whenever  possible.  There  are  several  reasons 
why  short  sittings  are  most  desirable.    To  keep 


104  SUCCESS  IN   PRACTICE 

a  patient  too  long  in  the  chair  is  to  run  the  risk 
of  nervous  strain,  and  in  fact  the  fortitude  of 
many  a  patient  has  in  this  way  been  broken  so 
as  to  engender  a  vivid  dread  of  dental  operations 
ever  after.  In  the  highly  nervous  organisms 
with  which  we  are  called  upon  to  deal  in  these 
days  of  stress  it  is  taking  serious  chances  to 
detain  a  patient  under  a  dental  operation  for 
three  or  four  hours  at  a  time,  as  is  sometimes 
done.  It  is  also  a  severe  tax  on  the  dentist  to 
operate  for  one  individual  so  long.  A  change 
from  one  patient  to  another  breaks  the  monot- 
ony of  operations  and  proves  a  rest.  Then 
again  where  long  appointments  are  arranged 
with  patients  it  is  a  more  serious  matter  to  have 
an  appointment  broken,  and  entails  a  greater  loss 
either  on  patient  or  operator,  than  where  short 
sittings  are  the  order.  Another  minor  considera- 
tion relates  to  the  impression  on  the  patient  as 
regards  the  size  of  the  bill.  To  many  individuals 
a  sitting  is  a  sitting  and  they  make  little  dis- 
crimination between  one  of  two  hours  and  one 
of  three  hours,  while  the  difference  to  the  dentist 
is  quite  appreciable.  Usually  a  patient  will  more 
cheerfully  pay  a  reasonable  fee  for  eight  sittings 


APPOINTMENTS  AND  SITTINGS  105 

of  one  hour  each  than  they  will  for  two  sittings 
of  four  hours  each. 

Under  ordinary  circumstances  it  is  never  well 
to  give  a  longer  sitting  than  two  hours,  and  with 
most  of  our  operations  one  hour  is  ample.  Of 
course  the  operator  should  never  crowd  his  ap- 
pointments to  the  extent  of  interfering  with 
perfect  service,  but  the  tendency  of  the  day 
should  be  towards  short  sittings  rather  than  long 
ones. 


VIII 

GIVING  CREDIT,  COLLECTING  ACCOUNTS.  PAYING 
BILLS 

The  evil  of  long  credits  is  one  of  the  greatest 
abominations  attaching  either  to  the  professions 
or  to  trade,  and  yet  with  the  established  customs 
of  the  day  it  seems  necessary  for  the  dentist  to 
occasionally  extend  credit  to  his  patients.  The 
nature  of  the  work  is  such  that  to  give  a  bill  at 
each  sitting  is  burdensome,  and  in  many  in- 
stances with  certain  patients  of  the  very  highest 
class  it  would  be  embarrassing,  so  that  short 
credits  at  least  seem  inevitable.  This  of  itself 
would  not  constitute  a  serious  evil  if  these  same 
short  credits  did  not  too  often  become  long  ones. 
Lengthy  credits  are  wrong  in  principle  and  ex- 
asperating in  practice,  and  the  dentist  should 
so  conduct  his  affairs  that  it  soon  becomes  mani- 
fest to  his  patients  that  he  is  opposed  to  giving 
unlimited  credit. 

There  are  two  phases  of  the  question  for  the 
io6 


COLLECTING  ACCOUNTS,  ETC.  107 

young  practitioner  to  consider, — the  persons  to 
wliom  credit  shall  or  shall  not  be  given,  and  the 
length  of  time  that  shall  be  extended  to  those  to 
whom  it  is  deemed  advisable  to  give  credit. 
When  new  patients  apply  to  the  dentist  for  his 
services  it  is  usually  customary  for  them  to  men- 
tion the  name  of  the  person  who  has  referred 
them.  If  a  stranger  asks  to  have  work  done 
without  some  reference  of  this  kind,  it  is  best  for 
the  dentist  to  adroitly  bring  up  the  subject  in 
some  inoffensive  way.  He  must  sail  his  bark 
between  the  Charybdis  of  offending  a  possible 
prospective  and  desirable  patient  and  the  Scylla 
of  doing  work  for  a  possible  dead  beat.  If  no 
other  opportunity  presents,  it  is  well  to  remark 
in  a  casual  way,  as  if  it  were  merely  incidental 
and  without  special  significance :  "  Did  one  of 
my  patients  refer  you  to  me?"  This  will  force 
an  answer  without  giving  offence,  and  the  char- 
acter of  this  answer  will  readily  determine  the 
dentist  in  his  subsequent  management  of  the 
case.  If  the  answer  is  too  non-committal  and 
unsatisfactory,  the  dentist  should  not  hesitate  to 
say  in  a  kindly,  gentlemanly  manner  that  it  is 
customary  in  his  practice  to  have  some  kind  of 


Io8  SUCCESS   IN   PRACTICE 

reference  before  doing  work  for  strangers, — ex- 
cept so  far  as  it  relates  to  the  relief  of  pain.  It 
is  of  course  understood,  or  at  least  it  should  be, 
that  if  an  individual  is  suffering  it  is  the  duty 
of  the  dentist  at  any  or  all  times  to  relieve  the 
pain  with  absolute  disregard  to  the  credit  of  the 
patient;  but  with  anything  further  than  this  he 
is  perfectly  justified  in  making  an  issue.  No 
individual  of  any  intelligence  will  resent  a  state- 
ment of  this  sort  if  properly  put,  and  any  patient 
who  does  take  offence  is  better  under  the  patron- 
age of  some  other  dentist  who  cares  more  for 
the  number  of  patients  he  gets  than  he  does  for 
conducting  a  profitable  and  equitable  practice. 

If  a  stranger  applies  under  the  recommenda- 
tion of  a  patient  whose  own  credit  is  not  of  the 
best,  it  is  well  to  look  personally  into  the  stand- 
ing of  the  new  patient.  Usually  "  birds  of  a 
feather  flock  together,"  but  the  rule  is  not  invari- 
able, and  it  so  chances  on  occasion  that  a  very 
undesirable  patient  will  send  one  who  is  in  all 
ways  satisfactory.  The  whole  question  resolves 
itself  back  to  the  recommendation  already  made, 
for  the  dentist  to  become  a  close  student  of 
human  nature.    In  some  instances  the  most  acute 


COLLECTING   ACCOUNTS,  ETC.  109 

observer  will  be  deceived  and  will  be  led  to  be- 
stow his  confidence  where  it  is  not  deserved, 
but  in  general  the  man  who  studies  humanity 
closely  will  soon  learn  to  detect  the  imposters 
when  they  apply  to  him. 

In  cases  where  a  patient  comes  on  the  implied 
recommendation  of  another  patient  who  is  relia- 
ble, and  yet  there  exists  a  doubt  in  the  mind  of 
the  practitioner  as  to  the  stranger's  integrity,  it 
is  always  best  to  inform  himself  by  an  appeal  to 
the  individual  who  gives  the  recommendation. 
This  is  sometimes  a  delicate  matter  and  requires 
considerable  tact,  but  there  is  always  a  way  of 
doing  it  without  embarrassment  if  the  practi- 
tioner only  studies  the  situation.  It  may  simply 
be  necessary  to  drop  a  note  of  thanks,  expressing 
the  appreciation  of  the  practitioner  for  having 
recommended  Mr.  So-and-so.  This  is  always 
proper  in  any  event,  and  particularly  so  if  the 
individual  who  sends  the  new  patient  is  a  pro- 
fessional man.  This  note  of  thanks  opens  the 
way  at  once  for  an  exposure  of  the  fraud  in  case 
the  new-comer  has  used  the  other's  name  without 
warrant,  as  sometimes  occurs.  But  the  circum- 
stances may  be  such  in  certain  instances  that  the 


no  SUCCESS   IN   PRACTICE 

practitioner  feels  he  must  have  definite  infor- 
mation regarding  the  standing  of  the  patient 
making  apphcation  for  work,  and  under  these 
conditions  a  letter  something  like  the  following 
may  be  sent  in  those  instances  where  it  is  not 
convenient  to  see  personally  the  party  who 
recommends  the  patient: 

"  My  Dear  Sir  :  Mr.  So-and-so  has  just  ap- 
plied to  me  for  dental  service,  giving  your  name 
as  reference.  It  sometimes  happens  that  the 
names  of  very  worthy  people  are  used  in  this 
connection  by  individuals  who  are  not  altogether 
responsible  and  who  have  no  warrant  for  such 
use,  and  I  accordingly  venture  to  ask  what  you 
know  as  to  the  standing  of  the  gentleman  in 
question.  I  need  not  assure  you  that  any  in- 
formation you  may  give  me  will  be  held  in  the 
strictest  confidence,  and  I  also  beg  to  thank  you 
in  advance  for  the  favor.  I  enclose  a  stamp  for 
answer. 

"  Yours  very  truly, 


But  sometimes  conditions  arise  in  which  the 
practitioner  must  use  his  own  judgment  and 


COLLECTING   ACCOUNTS,  ETC.  m 

abide  by  the  consequences.  As  has  been  stated, 
the  best  of  obsen^ers  will  be  deceived  at  times, 
and  the  only  thing  to  do  under  such  circum- 
stances is  to  accept  the  situation  philosophically 
and  not  waste  time  or  energy  in  crying  over  the 
proverbial  "  spilt  milk." 

It  will  not  always  do  to  depend  solely  on 
appearances  in  judging  character,  as  was  once 
very  forcibly  illustrated  by  a  prominent  practi- 
tioner in  a  manner  the  details  of  which  are  so 
very  good  that  they  must  be  related. 

The  practitioner  in  question  had  arrived  at  a 
point  in  his  practice  where  he  was  eminently 
satisfied,  with  one  small  exception.  Said  he  to 
a  friend  one  day :  "  I  have  all  the  patients  I 
want  now,  in  fact  more  than  I  can  attend  to; 
but  there  is  one  family  in  this  State  that  I  par- 
ticularly desire  to  have  as  patients,  and  to  whom 
I  believe  I  am  entitled.  I  have  many  of  their 
friends,  and  for  a  long  time  I  have  been  anxious 
to  secure  them,  but  for  some  reason  I  have  never 
been  able  to.  That  is  the  governor's  family. 
If  I  had  them  I  should  be  perfectly  happy  so  far 
as  my  practice  is  concerned." 

Some  time  later,  as  the  practitioner  was  in 


112  SUCCESS   IN   PRACTICE 

the  midst  of  an  operation  one  day,  he  was  called 
to  the  reception-room  and  met  there  a  small, 
very  plainly-dressed,  and  altogether  unobtrusive 
individual,  who  said  he  wished  some  dental  work 
done.  The  practitioner  scrutinized  him  a  mo- 
ment and  concluded  that  he  would  not  make  a 
very  desirable  patient,  so  he  excused  himself  on 
the  basis  of  being  busy,  and  finally  referred  him 
in  a  bland  manner  to  a  fellow-practitioner  across 
the  hall  for  whom  he  had  no  very  particular 
liking. 

In  a  few  days  he  met  the  friend  again,  and 
his  first  salutation  was  to  congratulate  the  den- 
tist on  securing  the  governor  as  a  patient.  The 
practitioner  looked  at  him  blankly  a  moment, 
and  then  said :  "  I  don't  know  what  you  mean. 
The  governor  has  never  been  to  me." 

"  But  I  know  he  has,"  protested  the  friend. 
"  I  sent  him  to  you  myself,  and  in  fact  he  went 
direct  from  my  office  to  yours." 

The  practitioner  thought  a  moment,  and  then 
said :  "  Describe  him.  I  never  remember  having 
seen  the  governor." 

When  his  friend  had  finished  describing  the 
governor,  the  practitioner  was  pacing  the  floor, 


COLLECTING   ACCOUNTS,   ETC.  113 

smiting  the  air,  and But  his  remarks  will 

not  permit  of  reproduction  in  print.  Appear- 
ances are  sometimes  deceptive,  and  this  should  be 
borne  in  mind  in  judging  the  probable  responsi- 
bilities of  a  new  patient  who  applies  for  service. 
It  is  never  safe  to  wholly  condemn  a  man  till 
you  know  him,  any  more  than  it  is  to  implicitly 
trust  a  stranger  w-ithout  some  kind  of  reference. 
Collecting  Accounts. — For  a  practitioner  to 
be  a  poor  collector  of  accounts  is  to  work  an  in- 
justice not  only  on  himself  and  his  family  but 
on  the  people  whom  he  credits.  It  is  demoral- 
izing in  every  way  and  to  all  concerned  to  estab- 
lish a  habit  of  laxity  and  irresponsibility  in 
regard  to  the  just  payment  of  obligations,  and 
each  individual  in  a  community  wath  the  standing 
that  a  professional  man  usually  has  owes  it  as 
a  duty  to  those  about  him  to  maintain  integrity 
in  this  respect  to  the  extent  of  his  ability.  If  a 
patient  accepts  professional  services  and  then 
is  allow'ed  to  dally  along  indefinitely  \vithout 
paying  for  them,  he  is  quite  likely  to  lose  any 
appreciation  he  may  ever  have  had  for  the  value 
of  them,  and  eventually  ends  in  losing  respect 
for  the  practitioner.    The  longer  an  account  runs 


'114  SUCCESS  IN   PRACTICE 

the  more  difficult  it  becomes  to  collect  it,  and 
the  lapse  of  time  invariably  lessens  the  debtor's 
sense  of  his  obligation.  Another  particular  feat- 
ure of  the  case  relates  to  the  loss  of  patronage 
a  practitioner  often  sustains  by  letting  accounts 
run.  If  a  patient  owes  a  dentist  a  bill  and  subse- 
quently finds  that  more  work  is  needed,  it  is  the 
rarest  thing  for  the  patient  to  apply  to  the  same 
dentist  for  the  service.  On  account  of  that  long- 
standing bill  another  dentist  is  sought  out,  and 
if  he  chances  to  be  a  good  collector,  his  bill  is 
often  paid  readily  while  the  first  dentist  is  left 
to  sigh  for  his  money. 

As  to  the  frequency  with  which  bills  should  be 
rendered  the  dentist  must  be  governed  somewhat 
by  the  usages  of  the  locality  in  which  he  prac- 
tices, but  ordinarily  an  account  should  be  ren- 
dered on  the  first  of  the  month  following  the 
completion  of  the  work,  and  if  not  paid,  should 
be  rendered  monthly  after  that.  When  a  bill  has 
been  sent  the  second  or  third  time  in  this  way 
without  response,  the  patient's  attention  should 
be  called  to  the  matter  either  by  a  carefully- 
worded  and  polite  letter  or  by  a  tactful  collector. 
Usually,  if  the  dentist  has  an  assistant,  it  is  best 


COLLECTING   ACCOUNTS,  ETC.  115 

to  have  the  assistant  call  in  preference  to  a  pro- 
fessional collector,  as  this  is  less  likely  to  be 
resented.  Unless  there  is  some  satisfactory  ex- 
planation of  the  delay,  there  should  be  little  let 
up  on  the  patient  till  a  settlement  is  forced  in 
some  way.  There  is  a  trite  saying  that  "  it 
takes  all  kinds  of  people  to  make  a  world,"  and 
in  the  collection  of  accounts  it  is  equally  true 
that  it  takes  all  kinds  of  expedients  to  work  suc- 
cess. The  dentist  should  study  the  temperament 
of  his  patient  and  should  aim  to  appeal  to  him  at 
his  vulnerable  point.  Sometimes,  though  not 
very  often,  it  may  be  advisable  to  enter  proceed- 
ings in  court  to  force  the  payment  of  an  account, 
but  in  a  general  way  this  method  is  productive 
of  more  bother  and  worry  to  the  dentist  than 
the  results  will  warrant. 

In  any  event,  where  there  has  ever  been  diffi- 
culty in  collecting  an  account  from  a  patient,  un- 
less there  seems  some  good  reason  for  it  which 
is  satisfactory  to  the  dentist,  no  future  appoint- 
ment should  ever  be  given  without  a  definite 
understanding  in  regard  to  payment.  Let  the 
patient  see  that  you  do  not  think  lightly  of  de- 
ferred obligations,  and  the  impression  will  soon 


Il6  SUCCESS   IN   PRACTICE 

get  out  that  you  are  not  to  be  trifled  with  by 
irresponsible  people. 

Of  course  the  dentist  should  not  so  demean 
himself  as  to  give  rise  to  the  idea  that  he  is  a 
hard-hearted  money-grabber  and  absolutely  cal- 
lous to  the  sensibilities  of  his  patients.  He  must 
be  a  gentleman  above  all  things,  and  in  every 
instance  where  he  finds  it  necessary  to  be  strin- 
gent in  his  demands  he  must  temper  his  severity 
with  the  strictest  adherence  to  principle  and  the 
most  beneficent  administration  of  justice.  In 
no  case  should  he  ever  be  caught  doing  so  base 
a  thing  as  to  persecute  for  money's  sake  any 
poor  or  unfortunate  individual  who  through 
force  of  circumstances  has  found  himself  in- 
debted to  him.  While  he  administers  his  affairs 
with  business-like  promptness,  he  should  never 
ignore  the  behests  of  a  common  humanity  nor 
fail  to  extend  charity  where  charity  is  indicated. 

Form  of  Bill-Heads  and  Manner  of  Making 
Out  Accounts. — It  is  a  matter  of  some  conse- 
quence in  the  smooth  running  of  a  practice  to 
know  how  best  to  render  accounts.  It  should 
no  longer  be  considered  necessary  nor  in  good 
taste  for  a  professional  man  to  put  down  every 


COLLECTING   ACCOUNTS,  ETC.  117 

item  of  service  on  a  bill  when  it  is  being  ren- 
dered, the  same  as  the  grocer  or  dry-goods  man. 
Professional  service  is  something  distinct  from 
trade  or  barter,  and  everything  smacking  of 
trade  in  the  conduct  of  a  practice  should  be  dis- 
countenanced. Professional  men  should  so  de- 
port themselves  that  the  word  professionalism 
shall  stand  synonymous  with  honor,  and  to-day 
it  would  have  been  so  considered  had  they  always 
lived  up  to  their  highest  possibilities.  But  un- 
fortunately there  have  been  rogues  in  the  pro- 
fessions as  well  as  in  other  callings,  so  that  it  is 
difficult  to  conduct  a  professional  practice  along 
lines  strictly  in  keeping  with  the  best  traditions 
of  the  craft.  And  yet  every  practitioner  owes 
it  to  his  profession  to  so  manage  his  affairs  that 
the  public  is  made  to  realize  the  difference  be- 
tween the  ethics  of  professionalism  and  the  ethics 
of  trade,  and  this  can  often  be  done  by  the  man- 
ner of  rendering  professional  bills. 

The  style  of  the  bill-head  should  be  plain,  neat, 
and  typographically  perfect.  No  flourishing 
head-  or  tail-pieces  or  borders  should  ever  be 
used.  In  size  they  should  be  simply  large  enough 
so  that  when  folded  once  they  will  conveniently 


Il8  SUCCESS  IN  PRACTICE 

go  into  an  ordinary  envelope.  They  should  be 
made  of  good,  substantial  paper,  the  difference 
in  cost  between  good  paper  and  poor  paper  being 
so  trifling  as  not  to  enter  seriously  into  the  case 
when  the  maintenance  of  a  high  professional 
standing  is  considered.  Economy  in  these  par- 
ticulars on  the  part  of  a  professional  man  is 
always  prejudicial  with  the  most  desirable  class 
of  patronage. 

The  bill  should  be  made  out  simply  "  For  pro- 
fessional services,"  and  with  patients  who  have  a 
due  regard  for  the  dentist's  honor  and  confidence 
in  his  integrity  this  is  all  that  is  necessary.  But 
to  avoid  any  possible  misunderstanding,  it  is 
always  best  to  have  a  printed  foot-note  on 
the  bill-head  as  indicated  in  the  illustration  on 
page  119. 

One  reason  why  it  is  unsatisfactory  to  itemize 
an  account  is  because  it  frequently  becomes 
necessary  to  charge  twice  as  much  for  one  filling 
as  for  another  of  the  same  material,  and  the  lay 
mind  cannot  always  see  the  signficance  of  this 
without  a  verbal  explanation.  In  fact  there  are 
many  apparent  discrepancies  in  the  items  of  an 
ordinary  dental  bill  which  might  cause  needless 


COLLECTING  ACCOUNTS,  ETC. 


119 


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I20  SUCCESS   IN   PRACTICE 

dissatisfaction,  and  so  it  is  best  to  render  the 
account  "  For  professional  services."  But  there 
are  very  many  worthy  individuals  whose  educa- 
tion and  experience  in  professional  matters  have 
not  progressed  far  enough  to  enable  them  to 
accept  such  a  bill  without  considering  it  arbi- 
trary and  high-handed.  They  want  to  know 
something  more  about  the  service  they  are  pay- 
ing for,  and  it  is  for  the  benefit  of  these  people 
that  the  foot-note  is  printed.  It  at  once  dis- 
arms suspicion,  and  if  for  no  other  reason  than 
this,  the  keeping  of  diagram  records  is  a  very 
profitable  procedure. 

In  cases  where  work  is  done  for  the  various 
members  of  a  family,  and  the  bills  are  sent  to 
the  head  of  the  family,  it  is  well,  in  view  of  the 
fact  that  he  is  not  supposed  to  know  the  amount 
of  service  rendered  to  each  member,  to  indicate 
this  on  the  bill.  Every  precaution  should  be 
taken  in  rendering  an  account  to  disarm  pos- 
sible criticism  in  advance,  and  this  is  particu- 
larly true  in  dealing  with  new  patients.  After 
patients  have  been  coming  for  some  time  and 
have  become  accustomed  to  the  dentist's  methods, 
and  have  gained  confidence  in  him,  he  can  take 


COLLECTING  ACCOUNTS,  ETC.  121 

greater  latitude  without  misunderstandings,  but 
he  should  make  sure  of  his  ground  at  ever}-  step. 
A  bill  such  as  just  indicated  may  be  made  out  in 
the  manner  shown  on  page  122. 

A  discriminating  practitioner  will  soon  learn 
by  his  experience  with  the  individuals  who  come 
under  his  care  just  how  to  approach  them  with 
bills  to  the  best  advantage,  and  if  he  makes  this 
matter  a  study  he  will  eventually  be  able  to 
conduct  this  department  of  his  practice  with  very 
little  friction.  But  in  order  to  accomplish  this 
he  must  first  establish  a  reputation  for  absolute 
honesty  in  all  his  professional  dealings.  With 
this  as  a  basis  he  need  have  no  fear  of  conten- 
tion; and  if  contention  does  occasionally  arise, 
he  can  face  the  result  with  perfect  confidence  that 
whichever  way  the  issue  goes  he  will  have  no 
compunction  of  conscience  in  the  matter  and 
nothing  of  serious  import  to  grieve  over.  But 
unless  he  is  fundamentally  honest  he  will  never 
have  any  assurance  against  suspicion,  and  no  real 
resource  to  fall  back  upon  in  case  of  contention. 
If  men  were  far-sighted  enough  to  see  the  results 
of  doubtful  dealing,  surely  all  men  would  be 
honest  for  policy's  sake  if  for  nothing  else. 


122 


SUCCESS  IN  PRACTICE 


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COLLECTING  ACCOUNTS,  ETC.  123 

Paying  Bills. — In  intimate  conjunction  with 
the  close  collection  of  acounts  must  go  the  prompt 
payment  of  bills.  No  dentist  of  any  self-respect 
will  ignore  his  business  obligations  to  the  extent 
of  gaining  the  reputation  for  being  poor  pay. 
Carelessness  in  this  respect  is  almost  criminal, 
and  in  a  profession  like  dentistry-,  where  the 
invested  capital  is  small  and  the  obligations  not 
necessarily  large  or  numerous,  it  is  inexcusable 
to  form  the  habit  of  not  paying  legitimate  bills. 
It  is  usually  not  of  necessity  that  dentists  are  poor 
pay,  but  merely  because  their  business  methods 
are  lax  generally  and  because  they  allow  them- 
selves to  drift  into  shiftless  and  irresponsible 
habits. 

A  legitimate  business  obligation  should  be 
held  as  binding  and  as  sacred  as  any  other 
obligation  in  life;  and  if  a  man  plans  his  affairs 
properly,  it  is  as  easy  to  pay  a  bill  at  one  time 
as  another.  It  is  largely  a  matter  of  habit  and 
self-discipline.  Many  a  man  who  is  not  at  heart 
dishonest  carelessly  allows  himself  to  get  behind, 
and,  through  sheer  lack  of  decision  and  self- 
restraint  lets  matters  drift  along  month  after 
month  and  year  after  year  till  it  all  ends  in  a 


124 


SUCCESS   IN   PRACTICE 


total  loss  of  credit,  and  then  such  a  man  wonders 
why  the  world  is  hard  on  him. 

The  desire  to  have  things  without  the  ability 
to  pay  for  them  is  a  disease  which  when  chronic 
becomes  as  fatal  to  the  ultimate  self-respect  and 
happiness  of  the  individual  as  does  tuberculosis 
to  his  physical  system.  Many  of  the  things  we 
buy  in  our  modern  civilization  are  luxuries  in- 
stead of  necessities,  and  while  it  is  true  that  in 
the  constant  change  of  customs  and  tastes  the 
luxuries  of  yesterday  seem  to  become  the  neces- 
sities of  to-day,  it  is  yet  a  fact  that  many  of 
the  items  of  expenditure  in  the  life  of  the  aver- 
age individual  are  wholly  unnecessary.  It  is 
well  and  proper  for  a  man  to  have  some  of  the 
luxuries  and  to  indulge  his  taste  for  the  sublime 
and  the  refined  in  the  modern  amenities  of  life, 
but  it  is  not  well,  neither  is  it  proper,  to  do  this 
until  he  can  afford  it.  To  indulge  in  luxuries 
at  the  expense  of  one's  business  credit  and  repu- 
tation and  to  buy  luxuries  that  one  is  not  cer- 
tain of  paying  for  is  equivalent  to  downright 
dishonesty. 

Let  the  young  man  starting  out  in  life  be 
cautious  about  contracting  bills,  and  particularly 


COLLECTING    ACCOUNTS,   ETC.  125 

in  those  cases  where  there  is  the  shghtest  doubt 
about  his  abihty  to  pay.  Let  him  look  ahead 
very  carefully,  and  if  there  is  not  in  his  mind 
a  positive  assurance  that  he  can  meet  his  bills 
when  due,  let  him  resolutely  deprive  himself 
of  the  things  he  otherwise  would  buy  and  wait 
till  his  circumstances  so  change  that  he  will  be 
justified  in  the  purchase.  There  is  nothing  so 
discouraging  or  disheartening  to  a  young  man 
as  to  have  a  load  of  debts  hanging  over  him.  It 
may  be  necessary  under  certain  circumstances, 
in  fact  it  frequently  does  become  necessary  with 
a  young  dentist  starting  out  in  practice,  to  go 
in  debt  for  his  equipment,  but  it  should  be  his 
constant  aim  backed  by  the  closest  economy  to 
discharge  the  obligation  as  early  as  possible  and 
get  even  with  the  world.  To  be  out  of  debt  and 
able  to  look  every  man  in  the  face  is  a  wonderful 
satisfaction  to  any  right  thinking  individual,  but 
for  a  young  dentist  to  attempt  to  conduct  a  prac- 
tice with  the  collector  calling  at  his  office  every 
few  days  is  to  travel  an  uphill  road  filled  with 
rolling  stones  and  paved  with  briars.  It  is  not 
within  his  power  to  do  the  best  service  for  his 
patients  while  he  is  harrassed  by  debts. 


126  SUCCESS   IN   PRACTICE 

To  gain  a  reputation  in  the  community  for  the 
prompt  payment  of  accounts  estabHshes  a  man's 
credit  and  adds  immeasurably  to  his  self-respect. 
A  man  under  these  circumstances  can  confidently 
ask  for  credit  in  time  of  need,  and  people  are 
only  too  glad  to  accommodate  him.  There  is 
so  much  innate  goodness  in  humanity  even  in 
business  relations  that  there  is  never  lacking  the 
desire  to  help  those  who  attempt  to  help  them- 
selves, and  the  surest  way  to  gain  friends  is  to 
prove  one's  self  worthy  of  them. 


IX 

FEES 

There  are  two  principal  plans  for  arranging 
fees  in  a  dental  practice, — by  the  hour  or  by  the 
operation, — and  there  are  arguments  for  and 
against  each.  To  charge  wholly  by  the  hour  is 
in  some  respects  an  equitable  arrangement,  but 
there  are  objections  to  it  as  an  invariable  prac- 
tice. It  is  true  that  a  dentist's  time  is  his  chief 
stock  in  trade,  but  it  is  also  true  that  his  ex- 
penditure of  energy  is  an  important  element  in 
the  case,  and  there  are  some  operations  which 
tax  a  practitioner  far  more  than  others.  To 
have  a  set  fee  then  for  each  hour's  work  is  not 
just  to  the  operator,  and  to  have  a  sliding  scale 
according  to  the  character  of  the  operation  is 
practically  charging  by  the  operation.  Then 
again,  while  as  a  professional  proposition  the 
cost  of  material  should  never  enter  into  con- 
sideration in  arranging  fees  for  professional  ser- 
vice, yet  it  is  undeniable  that  in  some  cases  it 

127 


128  SUCCESS   IN   PRACTICE 

becomes  a  factor.  For  instance,  the  difference 
between  an  hour  spent  in  removing  deposits  and 
poHshing  teeth  and  one  spent  in  condensing  gold 
in  a  cavity  would  amount  to  something  in  the 
way  of  actual  cost,  to  say  nothing  of  the  dif- 
ference in  nervous  tension.  To  work  by  the 
hour  is  to  be  constantly  watching  the  clock,  par- 
ticularly if  the  operator  is  conscientious  and  has 
his  patient's  interest  at  heart,  and  there  is  always 
a  feeling  that  he  is  working  on  time  which 
belongs  to  somebody  else  instead  of  himself. 
Any  diversion  from  the  real  work  in  hand  or 
any  interruption  in  an  operation  seems  so  much 
of  a  direct  robbery  of  the  patient,  and  this  fact 
always  being  prominent  in  an  operator's  mind, 
makes  him  more  or  less  a  slave  to  his  surround- 
ings. Another  inequitable  feature  about  the  case 
is  the  fact  that  no  operator  is  able  to  give  uni- 
formly good  service  at  all  times.  There  are 
days  when  he  is  not  up  to  the  mark  and  when 
matters  move  slowly  despite  his  best  effort,  and 
there  are  other  days  when  he  is  in  the  highest 
perfection  of  physical,  mental,  and  nervous 
balance,  so  that  he  is  able  to  accomplish  twice 
the  work  in  a  given  time  that  he  can  on  other 


FEES  129 

occasions.  To  charge  the  same  fee  per  hour  for 
service  rendered  on  two  days  so  different  in 
accompHshment  is  not  equitable,  and  an  opera- 
tor cannot  well  say  to  a  patient :  "  I  am  not  in 
condition  to-day  to  do  the  class  of  service  I 
ordinarily  do,  and  so  I  must  not  charge  you  my 
regular  fee,"  no  more  than  he  can  say :  "I  am 
feeling  so  well  to-day  that  I  must  charge  you 
more  than  ordinarily." 

A  fee  should  be  based  on  the  amount  of  ac- 
complishment more  than  on  anything  else,  and 
this  fact  also  illustrates  a  frequent  injustice 
where,  on  the  other  hand,  charges  are  made  solely 
by  the  operation.  To  charge  a  set  fee,  for  in- 
stance, for  an  amalgam  filling  is  wholly  wrong, 
because  it  may  require  three  or  four  times  as 
long  to  insert  one  amalgam  filling  as  it  does 
another,  and  the  limit  of  accomplishment  in  the 
one  case  is  vastly  different  from  the  other.  The 
element  of  time  in  an  operation  cannot  therefore 
by  any  means  be  ignored,  and  the  most  equitable 
arrangement  is  to  have  a  combination  of  the  two 
systems  of  charging.  There  should  be  a  mini- 
mum fee  for  each  kind  of  operation,  and  the 
charges  should  run  upward  from  this  minimum 

9 


I30 


SUCCESS   IN   PRACTICE 


according  to  the  time  and  energy  required  in 
its  performance. 

As  to  the  size  of  an  operator's  fees  the  mat- 
ter must  of  course  be  regulated  to  some  extent 
by  the  customs  in  vogue  in  the  locaHty  where 
he  practises.  It  is  suicidal  in  every  particular  to 
make  one's  fees  lower  than  the  regulation  fees 
of  the  neighborhood,  as  it  is  also  usually  inju- 
dicious to  make  them  very  much  higher.  This 
applies  more  particularly  to  practices  in  smaller 
towns,  where  an  operator's  fees  are  a  matter  of 
common  gossip  and  where  the  precise  fee  for  a 
given  operation  becomes  well  known.  If  an 
operator  varies  in  any  way  from  the  regulation 
fees,  it  is  always  safer  to  raise  the  fees  than  to 
lower  them.  This  may  seem  a  strange  state- 
ment, and  yet  it  is  amply  borne  out  by  obser- 
vation. If  a  man's  fees  are  lower  than  his  neigh- 
bor's, there  is  always  a  suspicion  that  he  is  not 
so  capable  a  practitioner,  and  invariably  the 
cheap  man  draws  around  him  a  class  of  practice 
which  at  best  is  very  undesirable.  He  gets  the 
shoppers  and  the  misers  and  the  financially  irre- 
sponsible. His  is  the  patronage  of  the  "  great 
unwashed." 


FEES 


131 


To  establish  in  a  neighborhood  the  reputation 
of  being  the  highest-priced  dentist  in  the  place 
is  often  a  sheet-anchor  of  strength.  It  may  drive 
some  people  away,  but  if  the  fees  are  at  all  within 
reason  it  will  not  drive  very  many  worthy  peo- 
ple away,  and  for  one  such  who  leaves  a  dozen 
others  will  come.  In  fact  it  is  the  very  rarest 
thing  imaginable  for  a  dentist  who  is  capable  of 
giving  good  service  to  ever  lose  his  patronage 
on  account  of  high  fees.  Of  course  he  must  be 
sufficiently  skilled  to  justify  himself  in  charging 
well,  and  he  must  have  some  sense  of  honor  in 
making  his  charges ;  but  where  there  is  one  den- 
tist who  has  failed  on  account  of  high  fees  there 
are  ninety-and-nine  who  have  failed  from  other 
causes.  In  many  instances  high  fees  are  made 
the  scape-goat  of  a  man's  failure  when  the  real 
cause  was  something  else.  The  mere  fact  of  de- 
manding and  maintaining  good  fees  tends  to 
establish  confidence  in  a  man  and  draws  to  him 
the  most  desirable  people. 

.  When  a  young  man  starts  out  in  practice,  par- 
ticularly if  it  is  in  a  large  city  where  fees  vary 
greatly  among  practitioners,  he  cannot  expect  to 
get  as  high  fees  as  the  older  and  better  estab- 


132 


SUCCESS   IN   PRACTICE 


lished  practitioners;  but  as  he  gains  patronage 
and  experience  he  should  gradually  raise  his  fees 
till  he  gets  them  up  as  far  as  his  capabilities  will 
justify.  To  do  this  requires  some  tact  and  judg- 
ment. It  will  not  do  to  make  too  prominent  a 
display  of  the  fact  that  his  fees  are  being  raised. 
He  should  quietly  go  about  it,  stiffening  up  here 
a  little  and  there  a  little,  and  from  time  to  time 
as  the  opportunity  seems  propitious  he  should 
advance  his  minimum  fees  till  the  volume  of  his 
income  is  perceptibly  increased.  In  this  way  his 
practice  will  gradually  undergo  a  process  of  evo- 
lution without  any  serious  protest  on  the  part  of 
his  patients,  but  with  an  ultimate  weeding  out 
of  undesirable  patronage  and  the  establishment 
of  an  adequately  remunerative  fee  system. 

Estimating  Work.  —  In  some  instances  pa- 
tients make  a  request  to  have  the  cost  of  their 
work  estimated  in  advance,  and  while  this  seems 
to  them  a  perfectly  legitimate  and  natural  thing 
to  ask,  it  is  in  many  cases  a  very  difficult  matter 
to  comply  with  it,  and  under  certain  circumr 
stances  the  request  is  wholly  unreasonable.  It 
is  often  quite  impossible  to  predict  by  a  mere 
examination  of  the  teeth  the  extent  of  service 


FEES 


133 


it  will  require  to  put  them  in  a  healthy  condi- 
tion, and  the  patient  might  with  equal  propriety 
ask  a  physician  what  he  would  charge  to  carry 
them  through  a  case  of  illness  where  the  exact 
nature  of  the  disease  was  unknown  to  him.  This 
feature  of  the  case  should  be  fully  explained  to 
patients,  and  most  individuals  will  instantly  rec- 
ognize the  situation  and  see  the  justice  of  the 
dentist's  contention.  And  yet  it  is  necessary  for 
patients  in  many  of  the  exigencies  of  life  to 
know  something  of  the  obligations  they  are 
about  to  assume,  and  the  dentist  should  give 
them  as  accurate  an  idea  as  he  can.  In  esti- 
mating work  in  this  way  the  operator  should  in- 
variably explain  the  contingencies  of  the  case  to 
the  patient  and  should  emphasize  the  fact  that 
it  is  only  an  opinion  he  is  giving  as  to  the  prob- 
able cost  and  not  an  agreement  to  perform  the 
service  for  a  stated  amount.  Anything  in  the 
way  of  bargaining  over  a  dental  fee  should  be 
frowned  upon  by  a  self-respecting  practitioner, 
and  yet  this  has  no  reference  to  a  cordial  con- 
sideration of  the  question  of  cost  with  a  worthy 
but  impecunious  patient.  With  those  who  are 
so  situated  in  life  that  they  are  obliged  to  plan 


134 


SUCCESS  IN   PRACTICE 


their  expenditures  in  advance  it  is  well  to  esti- 
mate work  by  placing  the  probable  cost  between 
two  sums,  —  a  minimum  and  a  maximum 
amount, — with  considerabile  leeway  between  the 
two  to  allow  for  discrepancies  of  judgment. 

But  while  it  is  ordinarily  best — as  has  been  in- 
timated— to  avoid  giving  estimates  on  work  in 
advance,  it  is  occasionally  the  case  that  the  den- 
tist may  wish  to  force  a  consideration  of  fees  on 
the  patient  before  the  work  is  undertaken. 
Sometimes  irresponsible  people,  or  those  who 
may  not  be  familiar  with  the  dentist's  fees,  make 
appointments  for  work  without  sufficiently  con- 
sidering the  obligations  they  are  assuming,  and 
with  such  individuals  it  is  always  well  to  have 
some  sort  of  understanding.  The  time  to  bring 
this  about  is,  as  has  already  been  stated,  when 
the  examination  of  the  teeth  is  made  at  the  first 
sitting.  A  little  precaution  in  this  respect  will 
frequently  avoid  subsequent  complications  and 
unpleasantness. 

..  Other  instances  where  it  is  sometimes  well  to 
broach  the  subject  of  fees  before  the  work  is  be- 
gun is  where  a  child  or  ward  is  sent  to  the  den- 
tist by  a  father  or  guardian  and  the  mouth  is 


FEES 


135 


found  in  a  much  worse  condition  than  has  been 
suspected,  and  also  in  those  cases  where  the  pre- 
vious dentist  has  been  one  whose  fees  are  very- 
low.  Under  either  of  these  circumstances  the 
amount  of  the  bill  may  be  much  greater  than  had 
been  anticipated,  and  there  is  likely  to  be  dis- 
appointment and  sometimes  even  serious  dis- 
satisfaction when  it  is  rendered.  In  such  cases 
it  is  well  to  drop  a  polite  note  to  the  father  or 
guardian  informing  him  of  the  condition  of  the 
teeth  and  stating  that  the  practitioner  deems  it  a 
duty  to  him  to  apprise  him  of  the  facts  before 
doing  the  work. 

One  of  the  greatest  abominations  connected 
with  obtaining  legitimate  fees  is  to  have  patients 
come  from  a  man  whose  fees  are  notoriously 
low,  and  whose  patients  are  therefore  not  edu- 
cated to  a  just  appreciation  of  the  value  of  den- 
tal service.  When  a  responsible  practitioner 
gets  a  patient  under  these  conditions  he  must 
exercise  rare  judgment  and  tact  and  see  that  the 
patient  is  by  some  means  made  to  understand 
what  his  fees  are  in  advance.  Precautions  of 
this  sort  often  protect  the  dentist  against  charges 
of  extortion  and  dishonesty. 


136  SUCCESS   IN   PRACTICE 

Disputes  Over  Fees.  —  But  it  occasionally 
arises  in  the  conduct  of  a  full  practice  that  diffi- 
culties occur  in  adjusting  fees,  and  patients 
sometimes  dispute  a  bill  or  complain  of  its  size. 
The  only  safe  way  for  a  dentist  to  avoid  trouble 
of  this  sort  is  to  be  perfectly  equitable  and  just 
in  his  charges  at  all  times,  and  then  if  a  con- 
tention arises  he  is  in  a  position  to  say  to  the 
patient  that  his  bill  is  in  strict  accordance  with 
his  regular  fees.  If  the  patient  still  persists 
in  complaining,  it  is  in  order  for  the  dentist 
to  take  the  ground  in  a  gentlemanly  and  cour- 
teous manner  that  it  is  his  province  and  not  that 
of  the  patient  to  set  an  estimate  upon  his  ser- 
vices, and  that  while  people  are  not  obliged  to 
patronize  him,  when  they  do  come  they  must  let 
him  say  what  his  services  are  worth.  Above  all 
things  he  should  talk  reasonably  and  good- 
humoredly  to  the  patient  and  never  allow  him- 
self to  give  way  to  ill  temper.  The  moment  a 
man  gets  angry  or  the  least  bit  abusive  he  jeop- 
ardizes his  case  and  loses  his  advantage,  besides 
branding  himself  as  a  man  unworthy  to  be 
classed  as  a  professional  gentleman.  If  patients 
are  so  ignorant  or  overbearing  that  they  will  not 


FEES  137 

listen  to  reason  or  explanation,  it  is  better  for 
the  dentist  to  excuse  himself  from  their  presence 
and  refuse  to  have  anything  further  to  do  with 
them.  It  is  better  even  to  lose  a  bill  entirely 
than  to  stoop  to  an  unseemly  quarrel.  Make  it 
a  rule  with  patients  and  let  them  so  understand 
it  that  you  will  have  no  contention  over  accounts, 
and  when  this  is  well  established  as  a  tenet  of 
your  professional  faith  you  will  have  little  cause 
for  contention.  Not  only  this,  but  it  will  be 
found  that  in  the  course  of  a  year  there  will 
actually  be  fewer  accounts  lost  by  pursuing  this 
plan  than  by  continually  combating  people. 

The  Ideal  Status  of  the  Fee  Question. — But  in 
the  broadest  consideration  of  fees  and  the  best 
means  of  regulating  them  the  whole  matter  sifts 
itself  down  to  the  fact  that  the  ideal  condition 
in  the  conduct  of  a  practice  is  where  fees  are 
never  discussed  at  all.  To  be  continually  talk- 
ing fees  to  patients  is  degrading  and  smacks  too 
much  of  commercialism.  It  emphasizes  the  sor- 
did side  of  life  and  does  not  comport  with  the 
dignity  of  true  professionalism.  There  should 
be  eventually  established  between  patient  and 
operator  such  a  stable  confidence  and  such  a  com- 


138  SUCCESS   IN   PRACTICE 

munity  of  interest  that  it  is  never  necessary  with 
long-standing  patients  to  mention  the  subject 
of  fees  from  one  year's  end  to  another,  and  this 
very  condition  can  be  largely  brought  about  if 
the  operator  sets  himself  to  work  along  that  line 
as  he  is  building  up  his  practice.  But  it  cannot 
be  wholly  accomplished  at  the  outset  nor  till  the 
practitioner  has  demonstrated  his  integrity  to 
the  satisfaction  of  patients  and  established  a  firm 
conviction  in  their  minds  that  he  can  be  depended 
upon  for  equity  in  all  his  dealings.  When  this 
has  once  been  attained,  patients  simply  come  and 
have  their  work  done,  say  nothing  about  fees, 
and  expect  a  bill  on  the  first  of  the  following 
month.  A  check  is  then  mailed  to  the  dentist, 
who  receipts  the  bill,  or  has  his  book-keeper  do 
it,  and  returns  it  to  the  patient,  when  the  finan- 
cial part  of  that  transaction  is  forever  closed. 
To  maintain  a  practice  on  this  basis  is  the  acme 
of  professional  success  so  far  as  relates  to  the 
material  aspects  of  the  comity  between  patient 
and  practitioner,  and  such  a  condition  leaves  the 
dentist's  mind  free  from  the  baser  influence  of 
financial  bickering  and  gives  ample  opportunity 
for  the  closest  possible  attention  to  the  higher 


FEES  1 39 

development  of  his  professional  skill.  It  is  not 
only  better  in  a  financial  way,  but  better  men- 
tally and  morally  in  fostering  the  loftier  impulses 
of  honor  and  confidence  and  placing  human  in- 
tercourse on  a  more  exalted  plane  of  mutual 
equity  and  harmony. 

Charity  Work. — In  the  exigencies  of  profes- 
sional life  It  becomes  the  duty  of  every  prac- 
titioner of  dentistry  to  do  more  or  less  charity 
work,  and  this  should  be  most  cheerfully  done 
whenever  the  merits  of  the  case  warrant  it. 
\Mien  it  comes  to  the  relief  of  pain  the  question 
should  never  arise  as  to  the  patient's  ability  to 
pay.  There  are  many  unfortunate  circumstances 
occurring  in  the  lives  of  individuals  which  fre- 
quently throw  them  on  the  mercy  of  others,  and 
when  reverses  happen  among  his  patients  the 
dentist  should  never  be  remiss  in  his  duty  so  far 
as  exercising  charity  is  concerned.  He  should 
adopt  the  golden  rule  in  this  matter  as  in  other 
affairs  of  life. 

But  there  is  another  side  to  the  question  which 
must  be  faced  with  resolution  and  carried  out 
with  judgment.  The  dentist  should  have  a  care 
that  he  does  not  do  more  harm  than  g-ood  with 


I40  SUCCESS  IN   PRACTICE 

his  charity.  In  anything  he  does  beyond  the 
mere  relief  of  pain  for  a  patient  he  should  first 
make  certain  that  the  object  of  his  charity  is 
worthy,  and  even  then  he  should  not  carry  his 
benevolence  too  far.  This  is  not  so  much  be- 
cause of  imposition  on  himself  as  for  the  possible 
injury  to  the  object  of  his  charity.  There  is 
nothing  in  all  human  experience  more  demoral- 
izing to  an  individual  than  to  voluntarily  accept 
unlimited  charity,  and  the  moment  a  man  holds 
out  his  hand  and  receives  aid  from  another  with- 
out return  that  moment  he  sinks  in  his  own  self- 
esteem  and  loses  an  appreciable  segment  of  his 
character.  With  all  the  laudable  intentions  be- 
hind our  various  systems  of  charity  to-day,  it 
is  fast  becoming  evident  to  thoughtful  people 
that  more  injury  than  good  is  being  done  by 
them.  Many  of  them  are  merely  helping  to  cre- 
ate a  pauper  class  and  are  making  people  irre- 
sponsible and  dependent  who  otherwise  would 
develop  some  self-reliance.  After  giving  a  man 
a  certain  amount  of  aid  in  time  of  need  he  should 
be  thrown  on  his  own  resources  in  order  to  bring 
out  the  best  there  is  in  him.  Those  who  aim  to 
be  the  best  of  friends  to  man   are  often   led 


FEES 


141 


through  mistaken  charity  to  be  his  worst  ene- 
mies. Reach  down  your  hand  willingly  to  lift 
up  a  fallen  brother,  but  when  he  is  once  firmly 
set  upon  his  feet  let  him  stand  alone. 

Gtiaranteeing  Work. — The  request  is  some- 
times made  by  patients  to  have  their  work  guar- 
anteed. This,  as  every  practitioner  knows,  is 
an  unreasonable  request,  and  the  only  guarantee 
a  dentist  should  ever  give  is  to  guarantee  that 
he  will  do  the  very  best  he  knows  how  for  the 
patient's  welfare.  He  may  say  to  the  patient, 
and  in  fact  he  should  say,  that  if  his  operations 
fail  through  any  fault  of  his  he  will  cheerfully 
make  the  failure  good.  But  he  should  never 
under  any  circumstances  guarantee,  for  instance, 
that  fillings  will  remain  in  for  a  certain  number 
of  years  nor  that  a  set  of  artificial  teeth  will  wear 
a  given  time.  Unless  a  patient  has  suflEicient  con- 
fidence in  a  dentist  to  know  that  he  will  remedy 
any  defect  in  his  work  without  a  guarantee,  the 
attitude  of  the  patient  to  the  practitioner  is  not 
such  as  to  make  their  professional  relationship 
harmonious  and  satisfactory,  and  they  are  better 
apart.  A  physician  might  with  almost  equal 
propriety  be  asked  to  guarantee  that  when  he  has 


142 


SUCCESS   IN   PRACTICE 


once  cured  a  patient  of  an  illness  the  patient  will 
never  get  ill  again,  as  to  ask  a  dentist  to  guaran- 
tee his  work ;  and  no  practitioner  who  is  honest 
will  ever  be  led  to  do  so  unreasonable  a  thing. 


EMPLOYING  AN  ASSISTANT 

In  the  conduct  of  a  practice  which  is  at  all 
extensive  the  dentist  will  consult  his  best  inter- 
ests by  employing  a  young  lady  assistant.  No 
office  is  ever  kept  in  quite  the  pink  of  perfection 
without  the  ministrations  of  a  feminine  mind 
to  supervise  its  care  and  smooth  over  the  rough 
excrescences  left  upon  it  by  the  average  male 
habitant.  There  are  so  many  useful  services 
for  the  assistant  in  a  dental  office  that  an  oper- 
ator who  has  once  employed  one  will  never  be 
found  without  her.  She  stands  between  him  and 
many  of  the  pett\'  annoyances  which  would 
otherwise  fall  to  his  lot.  She  saves  nearly  one- 
half  of  his  time  by  dexterously  assisting  him  in 
his  operations  and  by  attending  to  the  clerical 
work,  such  as  making  appointments,  notif>*ing 
patients  to  come  for  examinations,  keeping  books 
and  records,  sending  bills,  and  the  hundred  and 
one  little  routine  details  of  an  office  practice.  She 

H3 


144  SUCCESS    IN   PRACTICE 

protects  him  from  the  ubiquitous  book-agent  and 
the  perennial  Hfe-insurance  man.  She  accepts 
the  blame  many  times  when  he  is  himself  at 
fault,  and  to  have  some  one  to  do  this  is  most 
delightful.  She  remembers  things  that  he  for- 
gets and  attends  to  all  his  memoranda.  She 
looks  after  the  linen  of  the  office  and  keeps  the 
instruments  cleaned  and  sterilized. 

In  fact  to  have  a  competent  assistant  is  to  re- 
lieve one's  self  of  many  of  the  small  cares  of 
conducting  an  office,  and  no  man  in  full  prac- 
tice can  afford  to  do  without  one.  It  is  economy 
in  every  way,  financial,  physical,  and  mental. 


XI 


ECONOMY   IN    PURCHASE   AND   IN   AVOIDING 

WASTE 

Purchasing  Instruments  and  Supplies. — If  all 
the  folly  of  dentists  in  purchasing  material  they 
do  not  need  were  represented  by  an  aggregation 
of  the  stuff  so  bought  it  would  create  a  pile  that 
would  reach  to  the  moon,  and  if  another  pile 
were  made  of  the  material  they  should  buy  but 
do  not  it  would  reach  equally  high.  This  might 
be  construed  into  an  intimation  that  they  do  not 
always  use  good  judgment  in  their  purchases, 
and  an  examination  of  the  average  dental  office 
will  amply  corroborate  the  inference.  It  is  sel- 
dom that  one  sees  an  office  which  is  too  well 
equipped,  but  it  is  quite  common  to  see  offices 
sadly  lacking  in  the  essentials  and  strewn  about 
and  lumbered  up  with  a  mass  of  material  of  no 
practical  utility.  A  certain  amount  of  such  accu- 
mulation seems  inevitable  in  years  of  experience, 

as  it  is  impossible  for  a  dentist  to  judge  accu- 

lo  145 


146  SUCCESS   IN   PRACTICE 

rately  with  regard  to  the  probable  utihty  of 
every  instrument  or  appHance  he  examines,  but 
that  a  man  may  come  much  nearer  it  than  most 
dentists  do  is  certain.  The  young  dentist  in  par- 
ticular should  form  the  habit  of  studying  care- 
fully the  instruments  he  buys,  and  should  ordi- 
narily see  a  practical  test  of  every  instrument  or 
appliance  before  he  purchases  it.  This  plan  of 
procedure  will  not  only  save  him  many  dollars 
in  the  course  of  a  year  but  it  is  really  of  great 
advantage  to  the  dealer  who  sells  him  his  sup- 
plies. To  purchase  an  instrument  that  proves 
inefifective  in  the  buyer's  hands  is  to  create  dis- 
affection, and  it  frequently  brings  about  the  re- 
quest to  have  the  instrument  exchanged  for 
something  else.  This  is  always  unsatisfactory 
to  the  dealer,  because  of  the  accumulation  of 
second-hand  material  for  which  there  is  very 
little  market.  The  irresponsibility  of  dentists 
in  not  knowing  just  what  they  want  and  in  pur- 
chasing what  they  do  not  need  is  proverbial  in 
our  supply-houses,  and  the  evil  is  so  great  to  all 
concerned  that  it  should  be  remedied  if  possible. 
The  dealer  is  not  in  a  position  to  remedy  it,  be- 
cause he  cannot  predict  whether  a  certain  appli; 


ECONOMY   IN   PURCHASE  147 

ance  will  appeal  to  a  given  operator  or  not. 
There  is  a  great  variation  among  men  as  to  their 
adaptability  to  instruments,  and  one  operator 
may  find  an  instrument  invaluable  to  him  in  his 
work  while  another  will  pronounce  it  useless. 
No  one  can  judge  of  this  matter  but  the  indi- 
vidual himself,  and  it  is  high  time  that  dentists 
made  a  more  discriminating  study  in  regard  to 
the  purchase  of  their  supplies. 

This  does  not  infer  that  they  shall  be  nig- 
gardly or  penurious  about  their  equipment.  No 
man  can  serve  his  patrons  in  the  highest  degree 
of  excellence  without  having  the  necessary  ap- 
purtenances to  do  it  with,  and  it  is  economy  both 
of  time  and  patience  to  have  the  most  perfect 
equipment.  A  well-appointed  dental  office  ap- 
peals to  patients  and  inspires  a  certain  amount 
of  respect,  while  it  gives  the  operator  a  greater 
d^ree  of  confidence  and  satisfaction. 

A  consideration  of  this  question  cannot  be 
complete  without  a  word  as  to  the  paying  of  bills 
for  supplies.  There  is  altogether  too  much 
laxity  among  dentists  in  regard  to  obligations 
of  this  sort,  and  it  is  a  serious  reflection  on  the 
profession  as  a  whole  that  many  practitioners 


148 


SUCCESS   IN    PRACTICE 


shirk  responsibility  in  this  particular  as  long  as 
possible.  They  seem  to  imagine  that  because 
the  dealers  make  their  living  on  the  patronage 
of  dentists,  the  latter  are  thereby  privileged  to 
take  all  sorts  of  liberties  and  ask  for  all  sorts  of 
favors.  Some  of  them  accept  it  as  almost  an 
affront  to  have  a  regular  monthly  bill  presented 
to  them,  and  if  a  draft  is  made  for  a  long  over- 
due account  it  is  construed  as  the  very  acme  of 
imperiousness  and  high-handed  usurpation. 
They  forget  that  business  is  business  and  that 
dealers  are  simply  business-men  with  business 
methods. 

It  must  of  course  be  taken  for  granted  that 
this  imputation  does  not  by  any  means  apply  to 
all  dentists.  There  are  many  in  the  profession 
who  pay  their  bills  promptly  and  are  in  no  wise 
open  to  the  charge  of  irresponsibility ;  and  even 
with  those  who  are  derelict  it  is  many  times  the 
case  that  it  is  due  more  to  carelessness  and  pro- 
crastination than  to  any  real  desire  to  escape 
their  just  obligations.  But  the  legitimate  way 
is  to  pay  bills  when  due,  or  rather  the  best  way 
of  all  is  to  have  no  bills  to  pay.  The  cash  buyer 
is  always  at  an  advantage  over  the  one  who  asks 


ECONOMY   IN    PURCHASE 


149 


credit,  and  in  dealing  with  dental-supply  houses 
an  appreciable  saving  may  be  made.  Most 
houses  have  a  rule  that  by  depositing  ninety 
dollars  with  them  the  depositor  is  given  credit 
for  one  hundred  dollars'  worth  of  supplies  to  be 
obtained  from  time  to  time  as  the  dentist  re- 
quires them,  and  there  is  no  rate  of  percentage 
that  pays  better  than  this.  It  is  a  profitable  ar- 
rangement in  every  way,  and  with  responsible 
houses  it  is  a  perfectly  safe  one.  As  soon  as  a 
dentist  begins  to  take  advantage  of  this  offer  his 
relations  with  that  particular  house  may  be  said 
to  be  on  a  very  satisfactory  basis,  and  if  any 
favors  are  to  be  shown  in  the  courtesies  of  com- 
mercial relationship  he  is  most  certain  to  be  the 
one  to  receive  them. 

Avoiding  Waste.  —  In  a  world  where  the 
genius  of  a  man  is  constantly  being  taxed  to  util- 
ize the  by-products  of  civilization  there  should 
be  a  universal  sentiment  against  undue  waste, 
and  in  the  commercial  world  this  is  true.  The 
waste  of  yesterday  becomes  the  staple  article  of 
commerce  to-day,  and  fortunes  have  been  made 
and  saved  by  preserving  the  rejected.  In  the 
practice  of  dentistry,  where  the  precious  metals 


I50  SUCCESS  IN   PRACTICE 

are  largely  used,  an  operator  may  gain  much  in 
the  course  of  a  year  by  carefully  saving  the  dust 
and  scraps.  Little  particles  of  gold  falling  to 
the  floor  during  the  operation  of  filling  should 
be  picked  up  and  kept  in  a  bottle.  Disks  or 
strips  used  in  finishing  gold  fillings  should  be 
preserved  and  sent  to  the  refiner.  The  platinum 
pins  in  broken  teeth,  the  dust  from  the  lathe  in 
grinding  gold  crowns,  bridges,  or  plates,  all  of 
them  should  be  carefully  gathered  and  saved. 
It  requires  little  time  to  do  this,  and  the  aggre- 
gate of  accumulation  from  this  source  in  a  life- 
time of  practice  would  make  the  average  man 
independent.  It  is  never  well  to  be  penurious 
about  anything,  but  it  is  always  well  to  be 
saving,  and  if  all  the  wanton  waste  of  the  world 
were  carefully  utilized  there  would  never  be  the 
need  for  deprivation. 


XII 

BANK   ACCOUNT   AND    INVESTMENTS 

A  YOUNG  man  should  establish  a  bank  account 
as  early  in  his  career  as  possible.  The  moment 
he  gets  a  few  dollars  ahead  he  should  put  it  in 
a  good  bank,  and  so  far  as  convenient  he  should 
pay  his  bills  by  check.  It  creates  a  favorable 
impression  in  the  community  and  gives  him  a 
more  stable  standing.  Besides  this,  a  check 
paid  for  a  bill  and  duly  endorsed  is  a  receipt, 
and  the  cancelled  checks  accumulating  month 
after  month  are  a  vivid  object-lesson  and  a  con- 
stant reminder  of  his  expenditures.  He  has 
more  confidence  in  himself  when  he  has  a  balance 
in  the  bank,  and  it  gives  him  a  greater  incentive 
to  save.  If  he  has  much  currency  in  his  pocket 
there  is  always  the  temptation  to  spend  it  for 
anything  which  may  catch  his  eye,  but  if  his 
money  is  in  the  bank  he  is  likely  to  think 
twice  before  drawing  on  it.  A  bank  account 
brings  him  in  contact  with  business  people  and 

151 


152  SUCCESS   IN   PRACTICE 

establishes  a  relationship  which  is  frequently  ad- 
vantageous to  him  in  the  way  of  profitable 
investments  by  the  time  he  has  a  sufficient 
accumulation  to  seek  investment. 

This  matter  of  investing  one's  earnings  profit- 
ably is  a  very  important  consideration  for  the 
professional  man  and  should  be  studied  with  the 
same  care  that  is  given  to  other  material  factors 
of  life.  A  man's  professional  usefulness  does 
not  continue  unabated  to  old  age,  and  unless  he 
saves  something  in  his  palmy  days  he  is  likely  to 
face  want  in  his  declining  years.  There  is  no 
more  pathetic  spectacle  than  an  old,  broken- 
down,  penniless  dentist,  worn  out  by  years  of 
service  at  the  chair  or  the  bench,  his  patients 
slipping  away  one  by  one,  till  finally  the  last 
loyal  patron  seems  to  have  abandoned  him  for 
a  younger  man,  and  he  left  with  nothing  but  re- 
grets, to  face  a  meagre  existence  eked  out  by 
charity.  That  this  has  been  the  lot  of  many  a 
practitioner  who  in  his  day  was  capable  and 
active  is  only  too  apparent,  and  it  should  prove 
an  object-lesson  for  the  young  men  of  the  hour 
to  so  shape  their  affairs  that  when  the  hand  be- 
gins to  lose  its  cunning  and  the  brain  to  be  less 


BANK  ACCOUNT  AND  INVESTMENTS   153 

alert  they  will  have  something  laid  away  to  en- 
sure their  independence.  How  doubly  sweet  it  is 
for  an  old  man  to  be  able  to  dispense  charity  in 
his  latter  years  instead  of  being  obliged  to  ac- 
cept it. 

As  to  the  kind  of  investments  suitable  for 
a  professional  man  he  must  be  governed  largely 
by  the  nature  of  his  surroundings,  and  no  ex- 
plicit advice  can  be  given ;  but  there  is  one  fea- 
ture of  the  case  that  every  young  man  should 
be  warned  against.  The  frantic  craze  to  become 
suddenly  rich  has  wrecked  more  men  than  any 
other  one  factor  of  commercial  life,  and  the  ten- 
dency for  speculation  is  largely  backed  by  this 
desire.  It  is  the  most  alluring  of  all  phantasies, 
and  there  is  little  wonder  that  young  men  fall  by 
the  thousands  in  its  pursuit.  The  young  profes- 
sional man,  of  all  others,  should  avoid  this  siren. 
Even  if  speculating  were  a  profitable  and  legiti- 
mate procedure  he  is  not  so  situated  that  he  can 
expect  to  excel  at  it.  When  men  who  are  con- 
stantly studying  the  stock  exchange  and  the 
grain  market  frequently  find  themselves  on  the 
losing  side,  how  can  a  young  man  who  never 
gets  more  than  the  merest  occasional  glimpse  of 


154  SUCCESS  IN  PRACTICE 

the  inside  expect  to  speculate  successfully  ?  The 
moment  a  young  professional  man  begins  play- 
ing the  stock  exchange  or  the  wheat  pit  on  mar- 
gins, that  moment  he  begins  to  lose  a  grip  on 
his  practice.  A  speculative  procedure  diverts 
attention  from  professional  matters  and  unfits 
a  man  for  the  closest  possible  attention  to  his 
work. 

There  are  of  course  exceptions  to  every  rule, 
but  it  is  the  rarest  thing  imaginable  for  an  out- 
sider to  ever  make  a  competence  in  speculation, 
and  if  the  vast  sums  of  money  put  into  specula- 
tion by  professional  men  were  placed  beside  the 
amounts  they  have  made  thereby,  the  former 
would  bury  the  latter  so  deep  that  it  could  never 
be  detected. 

The  young  man  should  studiously  avoid  all 
the  myriad  glittering  schemes  for  making  money 
rapidly,  and  should  content  himself  with  slower 
but  safer  investments.  First  mortgages  or  good 
bonds  are  preferable  to  flyers  on  the  Board  of 
Trade,  and  a  safe  dividend-paying  stock  bought 
outright  and  placed  in  the  vault  will  beat  a  mar- 
gin speculation  nine  times  out  of  ten.  Of  course 
interest  on  mortgages  or  bonds  is  not  high,  but 


BANK   ACCOUNT  AND   INVESTMENTS        155 

it  is  one  of  the  most  marvellous  things  in  all 
business  experience  to  watch  how  interest  will 
accumulate  as  the  months  and  years  go  on.  A 
few  hundred  dollars  put  out  at  interest  each 
year  during  the  time  of  a  man's  greatest  earn- 
ing capacity  will  secure  him  a  competence  when 
he  is  old.  The  dentists  to-day  who  are  inde- 
pendent are  for  the  most  part  men  who  have 
saved  little  by  little  and  invested  it  safely,  rather 
than  those  who  have  speculated. 


XIII 

PROFESSIONAL    RELATIONSHIP   AND    CITIZENSHIP 

No  consideration  of  a  dentist's  success  in  life 
would  be  complete  without  reference  to  his  pro- 
fessional relationship  and  his  status  as  a  citizen. 
To  be  successful  in  the  truest  sense  of  the  word 
a  dentist  must  have  intimate  association  and  the 
most  cordial  relations  with  his  fellow-practition- 
ers. Whatever  else  he  may  get  out  of  life  in  the 
way  of  money  or  friends  there  is  always  a  void 
unless  he  numbers  among  his  most  intimate  asso- 
ciates the  members  of  his  craft.  There  is  some- 
thing wonderfully  sustaining  in  the  true  friend- 
ship of  those  working  along  similar  lines,  and 
it  is  perfectly  natural  that  a  mutual  interest 
should  develop  between  the  members  of  a  com- 
mon profession.  He  who  holds  himself  aloof 
from  this  kind  of  association  misses  much  in  life 
in  the  way  of  enjoyment  and  professional  prog- 
ress. No  man  can  advance  as  rapidly  alone  as 
he  can  by  the  aid  of  those  interested  in  the  same 
156 


PROFESSIONAL   RELATIONSHIP  157 

pursuits,  and  when  a  man  refuses  to  fraternize 
with  others  of  his  profession  he  injures  himself 
more  than  any  one  else.  Everything  pertaining 
to  professional  welfare  should  have  his  hearty 
support  and  loyal  endorsement.  To  hang  back 
and  be  an  odd  sheep  brands  him  at  once  as  being 
possessed  of  qualities  that  are  undesirable,  and 
this  judgment  is  passed  on  him  not  only  by  the 
profession  but  by  the  public  at  large.  There  is 
nothing  more  unprofitable  than  a  self-imposed 
ostracism. 

The  dentist  should  join  the  various  dental 
societies  of  his  locality  and  take  an  active  interest 
in  their  welfare.  He  should  write  papers  for 
them  and  should  contribute  to  the  periodical 
literature  of  his  profession.  He  may  not  be  able 
to  write  a  brilliant  paper,  but  every  man  has  it 
in  him  to  say  something  that  shall  be  of  benefit 
to  his  fellow-practitioners,  and  he  has  no  right 
to  withhold  it.  And  even  if  he  cannot  write, 
he  can  be  useful  in  other  ways  and  thus  leave  his 
impress  on  the  profession  in  such  a  manner  that 
he  will  be  a  distinct  personality  instead  of  a 
nonentity.  In  short,  he  should  consider  himself 
part  and  parcel  of  the  profession  and  not  a  mere 


158  SUCCESS   IN   PRACTICE 

excrescence  waiting  to  be  wiped  off  by  the 
breath  of  progress. 

Not  only  this,  but  he  should  take  a  vital  inter- 
est in  affairs  aside  from  the  profession.  A  man 
who  wraps  himself  up  in  any  one  pursuit  and 
thinks  of  nothing  else  is  prone  to  become  nar- 
row-minded and  self-opinioned,  and  in  all  hu- 
man relations  there  is  no  one  more  illiberal  than 
a  narrow-minded  dentist.  If  a  dentist  is  at  all 
active  in  mind  he  needs  some  outside  interest 
or  some  fad  as  a  diversion  from  the  grind  of 
professional  life,  and  if  he  is  not  active,  he  needs 
it  all  the  more  to  create  activity.  He  should  aim 
to  be  broad  in  his  sympathies  and  his  interests, 
and  should  remember  that  he  is  a  man  first  and 
a  dentist  afterwards. 

This  involves  the  obligation  of  good  citizen- 
ship, and  to  be  a  good  citizen  is  to  take  cogni- 
zance of  public  affairs.  It  means  that  the  indi- 
vidual should  vote  at  all  municipal.  State,  or 
national  elections,  and  in  order  to  vote  intelli- 
gently he  should  make  himself  familiar  with  the 
leading  questions  of  the  day.  This  does  not  im- 
ply that  he  shall  be  offensively  obtrusive  with 
his  political  beliefs  nor  that  he  shall  consort  with 


PROFESSIONAL   RELATIONSHIP 


159 


ward-heelers  or  unworthy  politicians,  but  that 
he  shall  look  upon  it  as  a  duty  to  take  an  interest 
in  the  proper  administration  of  government  and 
to  lend  his  aid  towards  the  election  of  worthy 
officials  for  this  purpose. 

To  sum  up  the  factors  which  enter  into  the 
making  of  a  successful  dentist,  a  man  should 
not  only  develop  his  professional  attainments  to 
the  highest  state  of  perfection,  but  he  must  aim 
to  provide  for  those  dependent  upon  him  by 
strict  adherence  to  a  sound  financial  policy  in  the 
conduct  of  his  affairs,  and  in  addition  he  must 
hold  true  to  his  obligations  to  the  profession  of 
his  choice  and  to  the  commonwealth  in  which  he 
lives.  A  dentist  who  fulfils  these  requirements 
to  the  best  of  his  ability  may  be  considered  to 
have  attained  all  in  a  material  way  which  his 
particular  lot  in  life  permits  of  him,  and  of  such 
a  man  it  can  never  be  truly  said  that  has  lived 
altogether  in  vain. 


THE    END 


0 


RK58 
Johnson 
Success  in  dental  pra€tice. 


J63 
Copy  2 


-^uiBiuNlVERSlTVUBRARiESlhsLsU) 

RK  58  J63  C.2 

K' dental  Kact|c.. 


2002306328 


